[The patient with pulmonary embolism or vascular emergency requiring intensive care].
Acute pulmonary embolism requires ICU management only for patients with hemodynamic instability who need artificial ventilation, or for hemodynamically stable patients with significant right ventricular dysfunction. For both patient groups, echocardiography is the most relevant diagnostic method. The main therapeutic consideration is on systemic thrombolysis. It is indicated in almost all patients with hemodynamic instability but only in selected cases of right ventricular dysfunction. All other patients receive standard anticoagulation only. A second vascular emergency scenario is type 2 heparin-induced thrombocytopeniae (HIT II) which may cause venous as well as arterial complications. Alternative anticoagulation has to be established from the first moment of clinical suspicion. It has to be continued in a therapeutic dosage if HIT II is confirmed, and has to be stopped if the diagnosis is refuted. The latter case is by far more frequent. Regarding arterial occlusions (acute limb ischemia, acral gangrene, iatrogenic vascular trauma) hints are given for the management in the setting of intensive care.
Schellong
S M
SM
Medizinische Klinik, Krankenhaus Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany. schellong-se@khdf.de
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004452:Echocardiography; D004636:Emergency Service, Hospital; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy*; D012121:Respiration, Artificial; D013921:Thrombocytopenia / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D015912:Thrombolytic Therapy; D014652:Vascular Diseases / Q000175:diagnosis* / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000628:therapy*
D000925:Anticoagulants; D006493:Heparin