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Acute Pulmonary Embolism in 24 year old male: A Case Study

Acute Pulmonary Embolism in 24 year old male: A Case Study. Ashley Tanner Natalie Newman Nicale Yarbrough. Anatomy. Lungs Heart Legs  Inferior Vena Cava  Right Atrium  Right Ventricle  Pulmonary Artery. Pulmonary Embolism (PE).

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Acute Pulmonary Embolism in 24 year old male: A Case Study

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  1. Acute Pulmonary Embolism in 24 year old male: A Case Study Ashley Tanner Natalie Newman Nicale Yarbrough

  2. Anatomy • Lungs • Heart Legs Inferior Vena Cava  Right Atrium  Right Ventricle  Pulmonary Artery

  3. Pulmonary Embolism (PE) • An embolus that is obstructing a pulmonary artery.1 • An embolus can be fatty tissue, a blood clot, air, or tumor cells. • Early detection is necessary because it obstructs blood flow to the heart which causes infarction.

  4. Case Study • 24 yr old male • Symptoms for over 1 year • Chest Pain • Dyspnea • Laying down to sitting up • 3 day hospitalization • Differential Dx • Allergies • Myocardial Infarction • Chest X-ray, EKG, CTPA

  5. Risk Factors • Age • BMI? • Congestive heart failure • Active malignant neoplasm • Chemotherapy • Hxsuperficial vein thrombosis • Hxvaricose vein procedure • Chronic renal disease? • Neurologic disease with extremity paresis • Previous central venous catheterization or transvenous pacemaker placement • Trauma • Surgery • Anesthesia • Nursing home • Hospitalization within 90 days.2

  6. PE Trends • Incidence rates increased markedly with age for both males and females3,4 • Study found that the incidence of PE actually decreased in across their 25-year study in both males and females3

  7. Diagnosis • Early diagnosis is fundamental, because immediate treatment is highly effective.5 • Signs and Symptoms • Chest pain • Dyspnea • Coughing • Shortness of breath • Diagnosing takes a combination of clinical assessment and diagnostic imaging

  8. Diagnostic Imaging Transverse CTPA Oblique CTPA Frontal Radiograph 29-year old male with no significant medical history, all pictures are showing the right upper lung.6

  9. Treatment • Embolectomy-Surgical intervention to remove the embolism. • Thrombolytic therapy-pharmacologic agents used to break up the embolism.7 • Urokinase • Streptokinase • tPA (tissue plasminogen activator) • Heparin-Blood thinning agent to stop the growth of the thrombosis. • Warfarin-Same functions as heparin.

  10. Prognosis • Untreated PE is associated with a 30% mortality rate.Treated PE mortality rate is only 8%.1 • One study demonstrated that PE patients reported a worse quality living then the general population.8 • In another study that was done on a sample 399 patients, 33 patients had a recurrence of pulmonary embolism within the year of follow-up.1

  11. Discussion • There are many differential diagnoses to chest pain that pulmonary embolism is often overlooked. • From an Athletic Trainer point of view we need to be aware if any athlete are on any anti-coagulants. • Early detection is key for a better prognosis.

  12. References • Carson, J. L., Kelley, M. A., Duff, A., Weg, J. G., Fulkerson, W. J., Palevsky, H. I., ... & Terrin, M. L The clinical course of pulmonary embolism. New England Journal of Medicine, 1992; 326(19), 1240-1245. • Heit, J. A., Silverstein, M. D., Mohr, D. N., Petterson, T. M., O'Fallon, W. M., & Melton III, L. J. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Archives of internal medicine, 2000; 160(6), 809. • Silverstein, M. D., Heit, J. A., Mohr, D. N., Petterson, T. M., O'Fallon, W. M., & Melton III, L. J. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Archives of internal medicine, 1998, 158(6), 585. • Goldhaber, S. Z., Visani, L., & De Rosa, M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). The Lancet, 1999 353(9162), 1386-1389.

  13. References Ctd. • Squizzato, A., Rancan, E., Dentali, F., Bonzini, M., Guasti, L., Steidl, L., ... & Ageno, W. Diagnostic accuracy of lung ultrasound for pulmonary embolism: a systematic review and meta‐analysis. Journal of Thrombosis and Haemostasis. 2013 • Casullo, J., & Semionov, A. Reversed halo sign in acute pulmonary embolism and infarction. Acta Radiologica,2013; 54(5), 505-510. • Wan, S., Quinlan, D. J., Agnelli, G., & Eikelboom, J. W. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism a meta-analysis of the randomized controlled trials. Circulation, 2004; 110(6), 744-749. • van Es, J., den Exter, P. L., Kaptein, A. A., Andela, C. D., Erkens, P. M., Klok, F. A., ... & Middeldorp, S. Quality of life after pulmonary embolism as assessed with SF-36 and PEmb-QoL. Thrombosis research, 2013; 132(5), 500-505.

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