Alex Lew

40 yo male 20hr flight from Australia Arrived with redness, warmth, edema on leg

Sudden onset of chest pain and SOB RR called upon LOC Diminished unilateral lung sounds on left side NP ordered venous doppler Vitals @ P 124, BP 162/94, R 32, O2 89% on 100% Labs CBC, metabolic panel WNL, ABG abnormal (resp.

alkalosis)

Arteriogram showed PE Successful embolectomy Heparin drip administered postop

Heparin (fast acting) Low Molecular Weight Heparin (LMWH) Warfarin (long term) NOACs (New Oral Anti-Coagulants) Apixaban Rivaroxaban Dabigatran

Used both as a stand alone treatment in

moderate cases of pulmonary embolism and in combination with other therapies

t-PA (Tissue-plasminogen activor) drugs Alteplase (Activase, t-PA)

Tenecteplase (TNKase, t-PA)

Streptokinase

u-PA (Urokinase-plasminogen activator)

Used in moderate to severe cases of PE

Carry risk of severe bleeding

Open Embolectomy

Catheter Assisted Embolectomy

Catheter Directed Thrombolysis

Thrombectomy

Used in life-threatening, emergency situations

Determined necessary with evidence of cardiogenic shock and severe right ventricular dysfunction

Surgery carries inherent risk of clotting, thus combination with anti-coagulation therapy

A small cone-shaped device that is implanted in the inferior vena cava just below the kidneys. (Temporary)

Recommended for patients who experience recurring DVT or pulmonary embolism in spite of anti-coagulant drug use

OR

For patients who would not be able to tolerate anti-coagulant drugs

Wonderful Space Age-y IVC Placement Video

Also this video

Pulmonary Embolism

DVT/PE Treatments

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Blaivas, A. (2014, February 13). Pulmonary Embolism. PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001189/

Chatterjee, et al. (2014, June 18). Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. Journal of American Medicine. Retrieved from http://jama.jamanetwork.com.mutex.gmu.edu/article.aspx?articleid=1881311&author=Chatterjee

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Inferior Vena Cava Filters. University of Michigan Department of Surgery. Retrieved from http://surgery.med.umich.edu/vascular/patient/treatments/ivc_filters.shtml

Meyer, G., et al. (2014). Fibrinolysis for patients with intermediate-risk pulmonary embolism. The New England Journal of Medicine, 370(15), 1402-11. Retrieved from http://search.proquest.com/docview/1514863291?accountid=14541

Matthews, J. C., & McLaughlin, V. (2008). Acute right ventricular failure in the setting of acute pulmonary embolism or chronic pulmonary hypertension: a detailed review of the pathophysiology, diagnosis, and management. Current Cardiology Reviews, 4(1), 4959. doi:10.2174/157340308783565384

Trial Exhibits Inc. (2011, December 23). IVC Filter Complications-Medical Animation. Retrieved from https://www.youtube.com/watch?v=qlaDA_FRA48