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Cardio > Trombembolism > Flashcards

Trombembolism Flashcards

1
Q

Trombembolism definitie

A

Ocluzia patului arterial pulmonar
Prin trombi grasime lich amniotic
Consecinta rapida e ivd acuta

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2
Q

Cum vine un embol

A

Din curc sistemica=>cava=>ad=>vd=>artera pulm=>arteriole pulm=> RETROGRAD PRESIUNE CRESCUTA=>IC DREAPTA!!!

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3
Q

Patogeneza tvp

A

Staza
Hipercoagulabilitate
Disf endoteliala

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4
Q

Facturi majori predispozanti trombembolism

Cresc de 10 ori sansa

A 
Protezare sold genunchi
Internare pt ima fia in ultimele 3 luni
Ic in ultimele 3 luni
Fractyra sold picior
Antecedente tbv
TRAUMA MAJORA
LEZIUNI MEDULARE
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5
Q

Factori medii predispozanti tvp

2-9 ori

A 
Operatie artroscopica genunchi
Bolia autoimune
Transfuzii sange
Linii venoase centrale
Chimioterapie
Ic sau iresp
Terapie cu stim eritropoetina sau substitutie hormonala
Ivf
Infectii
Malignitate
Contraceptive
Avc paralitic
POSTPARTUM
Boli inflamatorii intestinale
Tvsuperficiala
Trombofilia
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6
Q

Factori slabi tvp

A 
Repaus>3 zile
Dz
Hta
Imobilizare sezand
varsta
Operatii laparo
Obezitate
Sarcina/ANTEPARTUM
Vene varicoase
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7
Q

Raspunsul in tep depinde de

A

Marime embol
Status cardioapulmonar preexistent
Compensare neurohormonala

Se mentine initial dar dupa intra in soc

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8
Q

Teste dg in tep

A

D dimeri
Ekg

Imagistic:angioCt, scinti, ecocard

Utilitate redusa rx, rmn, angiopulm

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9
Q

Ekg in tep

A 
S1q3t3-mc ginn white
S1s2s3
Brd incomplet complet
Deviere ax dreapta
Tahicardie sinusala!!!!!!!!
Fia/flutter
Q in d3 si avf!!!!!!
Hipovoltaj membre
T negativ v1-v3,d3,avf(mai adant in v2 fata de v3)
Qr in v1=dilatatie de v drept
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10
Q

Rx in tep

A 
Normal
Condensare sau infiltrare
Atelectazie
Ascensionare hemidiafragm
Revarsat pleural
Olighemie focala(westermark)
Hiperemie pl contralarera
Dilatare artera pulm unilat
Dilatare vd-dar nu pe fata ci pe profil
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11
Q

Dc apare frecv la pac spitalizati

A

Imobilizati
Se deschidrateaza
Au alte boli procoag

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12
Q

Staza venoasa

A 
Valve incompetente
Imobilizare prelungita
Sarcina
Interventii chir majore 
Traumatisme majore
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13
Q

Leziuni ale peretilor sau efectul citokinelor tep

A 
Interventii chir
Traumatisme
Ima
Arsuri
Obezitate
Cancer
Fumat excesiv
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14
Q

Hipercoagulabilitate

A 
Contracteptive 
Sdr antifosfolipidic
Cancer
Obezitate
Fumat excesiv
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15
Q

Sdr antifosfolipidic ereditar

A

=trombofilie

Rez la prot cm
Multatie 20310
Hiperhomocisteinemie

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16
Q

Tep idiopatic

A

30%

Semn de neoplazie

17
Q

Ce ins hipotens art la un pacient cu epa

A

Pai disf de vs!
Asta vine si de la miscarea paradoxLa a septului

E la risc inalt!

18
Q

Tablou clinic tep

A 
Dispnee -aparitie brusca
Ortopnee
Polipnee
Sincopa-hipoperfuzie(isi revine ca intra mecanisme compensatorii) deci face o insuf card dr acuta(risc inalt)
Durere pleuritica
Durere retrosternala(poate sa fie chiar de la ischemia de vd)
Diaforeza
Tuse
Hemoptizie-infart pulmonar
Tahicardie sinusala!!!!!
Cuanoza
Edeme febra
19
Q

Dg tvp

A

Fr
Clinic
Metode img doppler venos cu vene necompresibile

Daca n are tbp nu ins ca n are tep

20
Q

D dimeri

A

Produsi de degradare
Fibrinoliza intra vasc

Predictiv negativ

21
Q

Tahicardia sinusala are un motiv

A

Sangereaza
Face febra
S a speriat
Tep

22
Q

Angioct

A

De electie
Iradiaza si folos subst ct
(Nu gravida nu ira)

Pana la artere segm

23
Q

Eco tep

A 
Trastoracic
Dilatare si hipokinezie (semn mcconell)
Miscare paradox siv
Reg tricusp
Colaps vci absent
Htp!!!! Bernuli!!

Trasesof
Vad trombu

24
Q

Ores normala in ad

A

Cam 5 mmhg

25
Q

Disf vd la eco

A

Vd dilatat
Apex facut mai mult din vd
Sept spre vs
Perete liber paralizat cu apex care se misca bn
(Apexul se misca si e inp ptc se face dg dif cu ima drept unde de la vasc nu se misca nimic)

26
Q

Scinti ventilatie perfuzie

A

Radiotrasor ca sa vezi daca nu i ventilat si un trasor pt perfuzie
Tipic nu se suprapun
Se face la gravide, ira, intoleranta subt ct

27
Q

Sdr clinice tep

A

Masiva dispn sincopa cianoza hta

Submasiva ta normala dar cu disf vd

Mica ta, fct vd si biomarkeri buni

Infarct pulm(durere, hemoptizie, frecatura pleurala, condensare, subfebra)

Embolie paradoxala(inchidere foramen ovale patent)

Embolie nontrombotica(aer, grasime, tumori, lich amniotic)

Cv de pneumonie??

28
Q

Abordare dg si terapie tep

A

Faza acuta, evaluare rusc de recurenta, ev etiologie

29
Q

Evaluare prognostica initiala

A

Instabilitate hemodinamica-risc inalt

Risc intermediar:n are instab hemodin, index pesi sau spesi pt a dif intrebintermediR inalt si intermediar scazut
+img vs si troponina

30
Q

Risc inalt trp

A

Instab hemodinamica

31
Q

Risc mic sau internediar tep

A

Fara instab hemodinamica

32
Q

Insta hemodin

A

Soc cardiogen Are nev de resuscitare

Soc obstructiv(tens sub 90 si end organ hipoperfusion)

Hipotensiune persostenta (t<90 sau scadere cu mai mult de 40)

33
Q

Pesi cu cat e mai mare e risc mai mare

A 
Varsta
Sex
Cancer
Ic cronica
Boala pulm cronica
Tahicardie
Tens sist <100
Polipnee
Temp <36
Status mental alterat
Oxihemoglobina <90
34
Q

Abordare pacient cu instab hemodinamica

A

Tte=> insuf vd
=>
Daca pot fac ct si pun dg
Daca nu incep trat

35
Q

Terapie tep

A

Reperfuzie:tromboliza embolrctomie terapie percutana

Trat disfunctiei de vd(suport volemic, norepinefrina, dobutamina, exigenare prin mb extracorporeala)

Anticoagulare

Insertie de filtru in cava

36
Q

Abordare risc intermediar

A

Instab hemodinamic nu e
Probabilitate mica:
D dimeri
Angioct

Probabilitate inalta:
Angioct

37
Q

Probabilitatea clinica de embolie pulm geneva

A 
Antecedente de tep
Frecv cardiaca75-95:>95)
Operatie in ultima luna
Hemoptizii
Cancer activ
Durere mb inn
Edem 
Varsta
38
Q

Tromboliza

A

Risc inalt si intermediar inalt

2sapt de la inc simpt

39
Q

Anticoagulare tep

A

La toti
Previne extensia lor
Risc inalt: hep nefractionala
Risc non unalt: hep greutate mica sau fondaparinux

+aco antivit k

1:44=>1:58

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