TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS最新文献_第3页

Talc Hurts: A Case of Excipient Lung Disease 滑石粉伤害:一个赋形剂肺病病例

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3527

A. Hudler, P. Moore, P. Hountras

引用次数: 0

Progressive Hypoxemia from Right Ventricular Infarction: Rescue with Dobutamine 右心室梗死进行性低氧血症:多巴酚丁胺抢救

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3515

J. Arcidi, M. Ereth, A.I. Kidess, C. Santolin, P.W. Kluge

引用次数: 0

RV Thrombus- a Hidden Iceberg Behind Sudden Deterioration in a COVID-19 Patient RV血栓——COVID-19患者突然恶化背后的隐藏冰山

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3505

S. Parthasarathy, D. Alejos, W. Li, A. Kakkar

{"title":"RV Thrombus- a Hidden Iceberg Behind Sudden Deterioration in a COVID-19 Patient","authors":"S. Parthasarathy, D. Alejos, W. Li, A. Kakkar","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3505","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3505","url":null,"abstract":"Patients with COVID-19 pneumonia are at higher risk of developing thromboembolic events including pulmonary embolism, deep vein thrombosis, ischemic stroke, and myocardial infarction. We report a case of a patient who developed a right sided ventricular thrombus despite being on therapeutic anticoagulation. A 49-year-old man with no past medical history was admitted to the hospital due to COVID-19 pneumonia. He was started on therapeutic Enoxaparin due to D-dimer of 17710ng/ml. Lower extremity duplex was negative for deep vein thrombosis. Patient was enrolled in Sarilumab trial and received the intervention on day 3 and 4 of admission. Initially patient's oxygen requirements decreased, and D-dimer levels trended down. But on day 11, patient was hypotensive, hypoxic to 84% on 5L NC. Differentials included-Pulmonary embolism, Progression of COIVD-19 pneumonia, ARDS, superimposed bacterial pneumonia. Further workup included repeat chest x-ray which showed resolving bilateral infiltrates. D-dimer was 4388ng/ml. A bedside echocardiogram showed right ventricular dilation and a large mobile echo-dense mass measuring 12mm∗11mm compatible with a Right Ventricular thrombus. CT chest revealed right lower lobe pulmonary embolus and evidence of right heart strain. Patient was transferred to the ICU. Enoxaparin was stopped, a bolus of tissue plasminogen activator (tPA) 50mg was administered over 2 hours followed by a 1mg/hr infusion. Heparin drip with a PTT goal of 30-50 seconds was administered simultaneously for 24 hours. Fibrinogen levels were checked every 6 hours to ensure levels remained above 150 mg/dl. After 24 hours, echocardiogram showed persistent RV mobile thrombus and McConnell's sign. The above infusion protocol was repeated for 24 hours. After tPA infusion patient O2 requirements down trended from nonrebreather 15L to NC 5L. Repeat echo showed resolution of RV thrombus. Repeat CTPE had no new filling defects. There were no bleeding events. Patient was transitioned to apixaban and transferred stable to the floors. Patients with COVID-19 are at higher risk of developing hypercoagulability and it is associated with a worse prognosis. Bedside echocardiogram is a rapid accessible test that can be used in acute decompensating patients. Consecutive doses of tPA appear to be a safe and effective option for the treatment of right heart thrombus. Infusion endpoint for such patients include significant bleeding, drop in hemoglobin by 2 g/dl, fibrinogen <150mg/dl, and/or thrombus resolution on echocardiogram. Our patient showed improvement after tPA infusion perhaps by the thrombus lysis or lysis of the microthromboemboli and fibrin deposits of the pulmonary microvasculature.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128283028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Comprehensive Management of Acute Pulmonary Embolism in Primary Care Using Telemedicine During the COVID-19 Pandemic COVID-19大流行期间远程医疗在初级保健中的急性肺栓塞综合管理

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3502

J. Chang, D. J. Isaacs, J. Leung, M. Reed, D. Vinson

{"title":"Comprehensive Management of Acute Pulmonary Embolism in Primary Care Using Telemedicine During the COVID-19 Pandemic","authors":"J. Chang, D. J. Isaacs, J. Leung, M. Reed, D. Vinson","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3502","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3502","url":null,"abstract":"Background: During the COVID-19 pandemic, there has been increasing reliance on telemedicine to provide timely, low-risk, and accessible care. This may include triage, diagnosis, and management of acute pulmonary embolism (PE). While major society guidelines recommend outpatient management of low-risk PE, little research has evaluated primary care-based management. We present a case of comprehensive clinic-based outpatient PE management using telemedicine, including video visit, telephone follow-up, and secure messaging in a system with an integrated electronic health record. Case Presentation: A healthy, active woman in her 70s with a remote history of provoked PE presented to her primary care physician (PCP) with 2-3 months of dyspnea on exertion during the COVID-19 pandemic. She denied chest pain, cough, fevers, and dyspnea at rest. There was no recent surgery, reduced mobility, or history of malignancy. The initial visit was conducted through secure video interface due to pandemic restrictions on in-person visits. The PCP noted that the patient appeared in stable condition without respiratory distress. Outpatient laboratory work-up showed normal complete blood count and elevated D-dimer of 2.41 mcg/mL (normal <0.5 mcg/mL). Results and next steps were discussed with the patient via secure messaging, at which time the patient reported mild improvement in symptoms. Outpatient computed tomography pulmonary angiography demonstrated new partial filling defects in the right segmental arteries. The presentation was categorized as low-risk with a probable Class II PE Severity Index score and no apparent Hestia criteria. The PCP obtained same-day telephone consult with hematology, who advised indefinite anticoagulation therapy. Rivaroxaban was promptly initiated. The pharmacy-led anticoagulation management service provided next-day patient education by telephone and supplemental instructions by secure messaging. The patient had a follow-up secure video visit with hematology one week after her PE diagnosis. After completing one month of rivaroxaban treatment, the patient requested to switch to dabigatran, with which she has continued. She has experienced no bleeding complications nor recurrence of venous thromboembolism. Discussion: Our patient's low-risk PE presentation was appropriate for outpatient management and was particularly well-suited for telemedicine given her familiarity with technology, established PCP relationship, access to diagnostic testing, and prior PE as well as anticoagulation experience. This case demonstrates that telemedicine may be used safely and effectively in the diagnosis and management of acute PE without the need for transfer to a higher level of care, given an eligible patient in the right care setting supported by adequate resources and infrastructure.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116805949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pulmonary Embolism Masquerading as Unstable Angina 伪装成不稳定型心绞痛的肺栓塞

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3499

A. Cecchini, Abin Varghese Thomas, M. Sedhom, B. Gajjar

引用次数: 0

Current Reports of a Reduced Dosage of Rivaroxaban in Older Patients Diagnosed Venous Thromboembolism 减少利伐沙班用于诊断为静脉血栓栓塞的老年患者的最新报道

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3490

X. Zhang, H. Chen

引用次数: 0

Pulmonary Arterial Hypertension and Arrhythmogenic Right Ventricular Cardiomyopathy 肺动脉高压和心律失常性右室心肌病

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3517

U. Nasir, T. Waheed, K. Syed, R. Reddy

引用次数: 0

Successful Reversal of Severe Pulmonary Arterial Hypertension After Transcatheter Closure of a Patent Ductus Arteriosus in a 47-Year-Old 47岁经导管关闭动脉导管未闭后严重肺动脉高压的成功逆转

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3520

G. Antonio, A. Rafanan

引用次数: 0

Right Heart Thrombus with High-Risk Pulmonary Embolism in COVID-19 Pneumonia, a POCUS Diagnosis 新型冠状病毒肺炎右心血栓合并高危肺栓塞的POCUS诊断

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3503

B. Gupta, L. Orr, N. Cobb

{"title":"Right Heart Thrombus with High-Risk Pulmonary Embolism in COVID-19 Pneumonia, a POCUS Diagnosis","authors":"B. Gupta, L. Orr, N. Cobb","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3503","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3503","url":null,"abstract":"Case Presentation: A 74-year-old female nursing home patient with a history of ischemic stroke, hypertension, and obesity presented with fever, dyspnea, and hypoxemia to the emergency department. A chest radiograph demonstrated diffuse bilateral infiltrates and a rapid COVID-19 PCR was positive. She was emergently intubated and developed hemodynamic instability requiring multiple vasopressors, and her extremities were noted to be cool and clammy. Point-of-care ultrasound (POCUS) revealed a large irregularly shaped mobile hyperechoic density transiting the tricuspid valve as well as a dilated right ventricle. She was started on unfractionated heparin for concern of acute pulmonary embolism, though she did not undergo diagnostic imaging due to her hemodynamic instability and COVID-19 status. Bedside findings were formally confirmed by an emergent formal transthoracic echocardiogram and intravenous alteplase was administered. Her hemodynamics stabilized shortly after and she was weaned from vasopressor support. A repeat POCUS the following day showed resolution of the thrombus. Discussion: COVID-19 has altered the risk-benefit calculus of many clinical activities, impacting the availability of imaging due infection control, transport, and staffing issues. POCUS can serve as an efficient diagnostic modality in times of limited resources and/or emergent situations requiring rapid bedside diagnosis. Management of a moderate-to-high risk pulmonary embolism (PE) with anticoagulation is a widely accepted practice, and thrombolytics should be considered when hemodynamic instability is present. However, the management is less clear when a right heart thrombus (RHT) is found. The incidence of RHT ranges from 4-18%, though its identification is expected to increase with the rising popularity and training of POCUS. A RHT is considered a medical emergency given the high propensity of progression to a PE and increased mortality rate. Treatment with thrombolytics in addition to anticoagulation has shown improved outcomes in retrospective studies and meta-analyses, and is favored when compared to anticoagulation alone or surgical interventions, however there are still no definitive guidelines regarding its routine use. With new treatment modalities such as catheter-directed thrombolysis and surgical embolectomy becoming more widely available, larger studies are needed to show which treatment choice is superior. Regardless, prompt diagnosis can be achieved with POCUS and therapy can be initiated sooner which is proven to improve outcomes and was demonstrated in the case above.","PeriodicalId":244282,"journal":{"name":"TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114430370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

McConnell's Sign from Pulmonary Hypertension in a Patient with COPD and HIV 慢性阻塞性肺病合并HIV患者肺动脉高压的麦康奈尔征

TP80. TP080 YELLOW SUBMARINE - PULMONARY EMBOLI AND OTHER CASE REPORTS Pub Date : 1900-01-01 DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a3519

G. Ibarra, M. Oliva, Minnie Malik, A. Poor, N. Bhatti

引用次数: 0