(精编)【持续性肾脏替代治疗CRRT英文精品课件】Thrombolysis In PE.pptVIP

* * Thrombolysis In PE Case III 54 y male POD #1 LLL lobectomy ? Ca PMH : HTN , A Fib , DM II , COPD Rx : Digoxin , Lasix , Metformin , ASA enalapril bronchodilator Post op SOB History Sudden onset of diaphoresis SOB No chest pain , fever , wheeze , cough No abdominal or leg pain 500 NS 1000 pentaspan was given ?BP 75/55 baseline 120/70 Examination BP 80/55 HR 90 A fib RR 25 Temp 37 Sat 94% on 5 L O2 Cool mottled skin , conscious +ve accessory muscles JVP difficult ? 5cm ASA Epidural in place Hospital Course Received tPA Hb 100 ?80 No heparin INR 2.5 CRRT ? FIO2 55% CI 3.2 on 1.5 mcg /kg Levo .5mcg/kg Millrinone Recurrent episodes of VT/ SVT ? multiple DC shocks Hospital Course OR pathology ? Hamrtoma Same condition for 3 days Family meeting Withdrawal of support Thrombolysis In PE Streptokinase RCT SK 1.5 million IU /1 hour Vs heparin 8 pt All 4 pt rx with heparin died postmortem shows massive PE All 4 with SK had hemodynamic improvement alive at 2 y follow up J Thromb Thrombolysis. 1995 Thrombolysis In PE rtPA Chest. 1990 Dec RCT rtPA 40-80 mg over 90-120 mint VS Placebo 13 patient End point hemodynamic effect clot resolution Initial improvement in rtPA PVR at 60 mint which didn’t last at 90 mint *