Approach to patients with pulmonary embolism in a surgical intensive care unit.
OBJECTIVE
Pulmonary embolism (PE) is a potentially life threatening disease. Clinical signs and symptoms allow the clinician to determine the pretest probability of someone having pulmonary embolism but are insufficient to diagnose or rule out the condition. This paper aims to study the clinical presentation, identify the risk factors and evaluate the diagnostic strategies and management of patients with PE.


METHODS
The medical files of 69 patients were searched, who were diagnosed with PE and who were admitted to the Surgical Care Unit.


RESULTS
Dyspnea, pleuritic pain, haemoptysis, fever and cough were the most common presenting symptoms. Risk factors for PE were found in 90% of cases. D-dimers assay was elevated in all cases (100%) and the other diagnostic strategies used showed great accuracy in confirming the pretest probabilities of PE. It is of high importance that 75% of the patients had deep vein thrombosis as assessed by venous ultrasonography. Mortality due to PE was approximately 6.9%.


CONCLUSIONS
PE can be often overlooked with hazardous consequences. Clinical evaluation in combination with spiral CT or lung scintigraphy and vein ultrasound and D-dimer level can establish the diagnosis in the majority of patients so that effective treatment to be started as soon as possible.
Grigorakos
Leonidas
L
Athens University School of Nursing, Intensive Care at Trauma, Hospital of Athens KAT, Kifisia, Athens, Greece. grigorakos@parliament.gr
Sotiriou
Evangelia
E
Myrianthefs
P
P
Michail
Anastasia
A
Koulendi
Despina
D
Zidianakis
Vasilis
V
Gianakopoulos
K
K
Baltopoulos
G
G
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D003422:Critical Care; D003952:Diagnostic Imaging; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D012307:Risk Factors; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014859:Warfarin; D006493:Heparin