PE and HTN
Terms
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- when to initiate warfarin
- when aPTT is therapeutic (about 5 days usually)
- pulm HTN conseq of sev factors:
- x sect area of resist vessels, pulm blood flow, perivascular P, blood viscosity, misc
- pulm HTN assoc with high mortality during
- surgery and anesthesia
- MOA of thrombolytics
- activate plasminogen--> plasmin which--> fibrinolysis and fibrinogenolysis
- thrombolytics
- streptokinase, urokinase, TPA
- vena caval interruption
- can't tolerated anticoagulants, use a filter
- when to monitor the aPTT
- every 6 hours until within goal of 1.5-2 times normal
- can dx nboth actue and chronic PE
- spiral computed tomography
- gold standard for PE dx
- pulmonary arteriography
- secondary pulmonary HTN
- has a known cause
- goal of pulmonary circulation
- to provide blood flow to match the supply of air
- effect of pulm HTN on vascular bed
- decreased cross sectional area and distensibility
- dx of abnorm in right vent
- electrocardiography
- Heparin MOA
- accelerates action of ATIII to prevent thrombus extension
- pathology of lung effect
- both lungs, lower lobes
- preferred heparin in DVT
- LMWH enoxaparin
- CCBs for tx of pulm HTN
- nifedipine and diltiazem
- thrombolytics rec in patients with
- hemodynamic instability and severely compromised oxygenation
- Direct thrombin inhibitors
- lepirudin and argatroban
- lerpirudin
- from leech saliva, excreted from kidneys
- other dx that is $ and difficult in critically ill patients
- magnetic resonance imaging
- argatroban
- metabolized in the liver
- most common PE dx test
- VQ scan
- platelets release this, it increases pulmonary vascular resistance
- serotonin
- primary pulmonary HTN
- no demonstratable cause
- diseases where pulm HTN freq detected
- COPD, idio pulm fibrosis, sarcoidosis, histiocytosis X, neuromus/chest wall dis, central and obstructive sleep apnea
- vasodilators for tx of pulm HTN
- Na nitroprusside and nitroglycerin; adenosine; prostacyclin (I2)
- other sxs of PE
- hypoxemia and dyspnea
- vasodilators
- prostacyclins, NO
- most common signs of PE
- tachypnea and tachycardia
- underlying hemodyn changes--> pulm HTN
- dysfunctional pulm vasc endothelium
- Pulmonary HTN
- pressure within the pulmonary arterial system elevated
- vasoconstrictors
- endothelin (ET1)
- dx test in abnormal patients with acute PE
- chest radiography
- hypoxemia in PE due to
- high ventilation perfusion ratio
- TX of pulm HTN
- vasodilators, CCBs, heart-lung transplant