Emergency management of incidental pulmonary embolism (IPE).

Emergency Cancer Care Pub Date : 2022-01-01 Epub Date: 2022-06-20 DOI:10.1186/s44201-022-00004-7
Carme Font, Tim Cooksley, Shin Ahn, Bernardo Rapoport, Carmen Escalante
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引用次数: 3

Abstract

Venous thrombo-embolic (VTE) disease is a common cause of complications in patients with cancer and is the second most common cause of death in oncology patients other than the malignant disease. Whilst symptomatic VTE comprises the majority of such presentations to an emergency department (ED), incidental pulmonary embolism (IPE) is an increasingly frequent reason for attendance. Many studies report that the consequences of IPE do not differ significantly from those with symptomatic presentations and thus most guidelines recommend using the same approach. The complexity of treatment in cancer patients due to increased prevalence of co-morbidities, higher risk of bleeding, abnormal platelet and renal function, greater risk of VTE recurrence, and medications with the risk of anticoagulant interaction are consistent across patients with symptomatic and IPE. One of the initial challenges of the management of IPE is the design of a pathway that provides both patients and clinicians with a seamless journey from the radiological diagnosis of IPE to their initial clinical workup and management. Increased access to ambulatory care has successfully reduced ED utilisation and improved clinical outcomes in high-risk non-oncological populations, such as those with IPE. In this clinical review, we consider IPE management, its workup, the conundrums it may present for emergency physicians and the need to consider emergency ambulatory care for this growing cohort of patients.

Abstract Image

偶发性肺栓塞(IPE)的急救处理。
静脉血栓栓塞(VTE)疾病是癌症患者并发症的常见原因,是肿瘤患者除恶性疾病外的第二大常见死亡原因。虽然症状性静脉血栓栓塞(VTE)占急诊科(ED)的大多数,但偶发性肺栓塞(IPE)是一个越来越常见的就诊原因。许多研究报告说,IPE的后果与那些有症状的表现没有显著差异,因此大多数指南建议使用相同的方法。由于合并症患病率增加,出血风险增加,血小板和肾功能异常,静脉血栓栓塞复发风险增加,抗凝药物相互作用风险增加,癌症患者治疗的复杂性在症状性和IPE患者中是一致的。IPE管理的最初挑战之一是设计一条途径,为患者和临床医生提供从IPE放射诊断到初始临床检查和管理的无缝旅程。增加门诊护理成功地减少了ED的使用,并改善了高危非肿瘤人群(如IPE患者)的临床结果。在这篇临床综述中,我们考虑了IPE的管理,它的检查,它可能给急诊医生带来的难题,以及对这一不断增长的患者群体考虑急诊门诊护理的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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