I had a submassive PE with saddle emboli when I was 28y/o. I was s/p ankle surgery and on OCPs. My BNP was in the upper 300s and my right heart strain was so severe that I was in heart failure. It was so severe that they considered thoracotomy, but they decided to take me to IR for debulking with EKOS, the leaving the catheters in for an extra 24-hrs to continue the direct TPA. Somehow I was hemodynamically stable the whole time. Still, my doctor said I was incredibly lucky to have survived. I was in the ICU for 3 days, and tele for 2 more. A year and a half later I developed another PE from an IV stick in my left arm that thrombosed. I'm now on Eliquis for the rest of my life.
Pulmonary Embolism (PE; 200k Mortality Prevalence) and Deep Venous Thrombosis ([DVT]: 75% Association) have the Differential Diagnosis of the following: 1) Anemia; 2) Pneumothorax; 3) Community Acquired Pneumonia (CAP); 4) Arrhythmia; 5) Myocardial Infarction (MI); and 6) Congestive Heart Failure (CHF). Risk Factors of DVT are the following: 1) Venous Stasis; a) Bed Rest; b) Status Post Surgery; c) Obesity; 2) Injury to the Vessel Wall: 3) Hypercoagulability: a) Oral Contraceptive Pills (OCP); b) Exogenous Hormones; c) Factor V Leiden (FVL); d) Protein C or S Deficiency; e) Antiphospholipids Syndrome: and f) Pregnancy. Signs and Symptoms for DVT are: 1) Leg Swelling and Pain: 2) Warmth and Edema of Skin over Leg: 3) Pitting Edema; 4) Homan's Signs or Calf Pain on Dorsiflexion. Laboratory Investigations show an Elevated D-Dimer. When Subject is Stable a Duplex Ultrasound over the leg can confirm DVT, where Treatment (Tx) is Direct Oral Anticoagulant (Apixaban or Dabigatran et al). For PE the following is Standard: 1) SSx: 1) Signs and Symptoms of DVT; 2) Pleuritic Chest Pain; 3) Respiratory Distress/Dyspnea; 4) Tachycardia; 5) Jugular Venous Distension/Elevated Pressure and 6 Hemoptysis; where Laboratories show 1) Respiratory Alkalosis (ABG Finding); 2) Increased A-a Gradient (ABG Calculation); 3) Elevated D-Dimer (D-Dimer Test); and 4) Elevated B Type Natriuretic Peptide (BNP) ; 3) Diagnosis (Dx) is made via a Spiral Computed Tomography Imaging (Radiology with Contrast) where Angiography is even more Sensitive and Specific (High Mortality Invasive Procedure) and V/Q Scan if Spiral CT is contraindicated (Renal Failure, Pregnancy, or Contrast Sensitivity); Chest X Ray is useful initially as to eliminated Pneumonia, Pneumothorax and Myocardial Infarction Suspicions (DDx) but frequently normal for PE and an Echocardiogram can show Right Heart Strain if Severe PE or be normal in Asymptomatic to Mild PE; Treatment (Tx) and Management (Mx) of PE includes 1) Admission to Telemetry Unit; 2) Supplemental Oxygen (O2); 3) Direct Oral Anticoagulants (DOAC) as in Xa Inhibitors or Direct Thrombin Inhibitors and Anticoagulation Therapy for 6 Months (Post Discharge Treatment) if Hemodynamically Stable ( 1) No Hypotension; 2) No Tachycardia; 3) No ARDS: or 4) No Right Heart Strain on Ultrasound); If Pregnancy is an issue then Low Molecular Weight Heparin (LMWH) is indicated. When Hemodynamically Unstable, Treatment is 1) Thrombolytic Therapy (tPA) or Surgery for Mechanical Removal of Clot if tPA Contraindicated. Both DVT and PE Subjects warrant Referral To Hematology for Hypercoagulation Workup. Boy, my first successful Massive PE Diagnosis and successful Thrombectomy referral. Just Kidding! MD Paul Bolin, Leben uns gebt Gesundheit aber man versstandt dass nicht!
Thanks so much Paul. Your videos have been a great source of good information for my medical journey. A little heads up on the Holmans sign not being used any longer since it a may dislodge a thrombus into a thromboembolus.
Hello Dr Bolin, thank you for all your exellent videos. I really appriciate your time, expertise and effort you put into making these videos. I'm not able to subscibe to your patreon page with the link on this video. Please advice how to subscribe as I would love to have access to all your videos. Once a again thank you so much for your fantastic videos. You are a God send.
Today's case seen Primi at 36wks preg. PMH x nill PSH X nill Done scan Svf cephalic active .liq normal placental ant up .efwt 2.7kg. Baby badder over dilate Need ur comments
![Seungmin "그렇게, 천천히, 우리(As we are)" | [Stray Kids : SKZ-PLAYER]](http://i.ytimg.com/vi/kAzmhLHePqU/mqdefault.jpg)
I had a submassive PE with saddle emboli when I was 28y/o. I was s/p ankle surgery and on OCPs. My BNP was in the upper 300s and my right heart strain was so severe that I was in heart failure. It was so severe that they considered thoracotomy, but they decided to take me to IR for debulking with EKOS, the leaving the catheters in for an extra 24-hrs to continue the direct TPA. Somehow I was hemodynamically stable the whole time. Still, my doctor said I was incredibly lucky to have survived. I was in the ICU for 3 days, and tele for 2 more. A year and a half later I developed another PE from an IV stick in my left arm that thrombosed. I'm now on Eliquis for the rest of my life.
Ohhh. Take care 😊
How old r u now?
You are awesome sir , I have been listening to your lectures from 2015
Pulmonary Embolism (PE; 200k Mortality Prevalence) and Deep Venous Thrombosis ([DVT]: 75% Association) have the Differential Diagnosis of the following: 1) Anemia; 2) Pneumothorax; 3) Community Acquired Pneumonia (CAP); 4) Arrhythmia; 5) Myocardial Infarction (MI); and 6) Congestive Heart Failure (CHF). Risk Factors of DVT are the following: 1) Venous Stasis; a) Bed Rest; b) Status Post Surgery; c) Obesity; 2) Injury to the Vessel Wall: 3) Hypercoagulability: a) Oral Contraceptive Pills (OCP); b) Exogenous Hormones; c) Factor V Leiden (FVL); d) Protein C or S Deficiency; e) Antiphospholipids Syndrome: and f) Pregnancy. Signs and Symptoms for DVT are: 1) Leg Swelling and Pain: 2) Warmth and Edema of Skin over Leg: 3) Pitting Edema; 4) Homan's Signs or Calf Pain on Dorsiflexion. Laboratory Investigations show an Elevated D-Dimer. When Subject is Stable a Duplex Ultrasound over the leg can confirm DVT, where Treatment (Tx) is Direct Oral Anticoagulant (Apixaban or Dabigatran et al). For PE the following is Standard: 1) SSx: 1) Signs and Symptoms of DVT; 2) Pleuritic Chest Pain; 3) Respiratory Distress/Dyspnea; 4) Tachycardia; 5) Jugular Venous Distension/Elevated Pressure and 6 Hemoptysis; where Laboratories show 1) Respiratory Alkalosis (ABG Finding); 2) Increased A-a Gradient (ABG Calculation); 3) Elevated D-Dimer (D-Dimer Test); and 4) Elevated B Type Natriuretic Peptide (BNP) ; 3) Diagnosis (Dx) is made via a Spiral Computed Tomography Imaging (Radiology with Contrast) where Angiography is even more Sensitive and Specific (High Mortality Invasive Procedure) and V/Q Scan if Spiral CT is contraindicated (Renal Failure, Pregnancy, or Contrast Sensitivity); Chest X Ray is useful initially as to eliminated Pneumonia, Pneumothorax and Myocardial Infarction Suspicions (DDx) but frequently normal for PE and an Echocardiogram can show Right Heart Strain if Severe PE or be normal in Asymptomatic to Mild PE; Treatment (Tx) and Management (Mx) of PE includes 1) Admission to Telemetry Unit; 2) Supplemental Oxygen (O2); 3) Direct Oral Anticoagulants (DOAC) as in Xa Inhibitors or Direct Thrombin Inhibitors and Anticoagulation Therapy for 6 Months (Post Discharge Treatment) if Hemodynamically Stable ( 1) No Hypotension; 2) No Tachycardia; 3) No ARDS: or 4) No Right Heart Strain on Ultrasound); If Pregnancy is an issue then Low Molecular Weight Heparin (LMWH) is indicated. When Hemodynamically Unstable, Treatment is 1) Thrombolytic Therapy (tPA) or Surgery for Mechanical Removal of Clot if tPA Contraindicated. Both DVT and PE Subjects warrant Referral To Hematology for Hypercoagulation Workup. Boy, my first successful Massive PE Diagnosis and successful Thrombectomy referral. Just Kidding! MD Paul Bolin, Leben uns gebt Gesundheit aber man versstandt dass nicht!
great lectures as usual, what about WELLS Criteria?
Thanks so much Paul. Your videos have been a great source of good information for my medical journey.
A little heads up on the Holmans sign not being used any longer since it a may dislodge a thrombus into a thromboembolus.
U really are a life saver for us medical students
Thanks for the lecture! I thought it is not recommended to do a homan’s sigh since you do not want to break the thrombus?
Hello Dr Bolin, thank you for all your exellent videos. I really appriciate your time, expertise and effort you put into making these videos. I'm not able to subscibe to your patreon page with the link on this video. Please advice how to subscribe as I would love to have access to all your videos. Once a again thank you so much for your fantastic videos. You are a God send.
So nowadays we dont give LMH?! ...thanks for your presentation
Great lecture! Would you please do updated OB vidoes too? I really like how how breaks material down!
Welcome back sir
Thanks for these videos Dr Bolin. 👍
Wow. That was a fantastic briefing!!! Thank you v much 🙏🏻🙏🏻
Amazing. Thank you 😊
I watch all these videos and ty for the updates too
According to the American society of hematology 2020 guidelines and amboss LMWH and warfarin are to be done before dabigatran but not apixaban .
In DVT
This is beautiful
Thank you sir for sharing this information:)
This is a great presentation. Do you have a Nephrology lectures? Thank you so much
Check his channel.
Sever varicose veins with pregnancy
Need ur comments. Treatment
Can you do fat embolism syndrome?
Nice info
Is there any benefit of looking for asymptomatic DVT among "high risk" BUT asymptomatic patients?
As far as screening? No.
Thanks
thax
Today's case seen
Primi at 36wks preg.
PMH x nill
PSH X nill
Done scan
Svf cephalic active .liq normal placental ant up .efwt 2.7kg.
Baby badder over dilate
Need ur comments
👍👍👍👍👍👍👍👍
The baby look like she loves you so much , babies can sense things , hope you are back to health soon in Jesus name 💕🌷💕🙏
😊