Embolus pulmonary

ʻO ka pulmonary embolus kahi paʻa o ke aʻa i loko o nā akemāmā. ʻO ke kumu maʻamau o ka paʻa ʻana he ʻōpala koko.

Hoʻokumu pinepine ʻia kahi embolus pulmonary e kahi kūmole koko e ulu i kahi aa i waho o nā ake. ʻO ke kīʻaha koko maʻamau ka mea hoʻokahi i loko o ka aa hohonu o ka ʻūhā a i ʻole i ka pelvis (ʻūhā wahi). Kapa ʻia kēia ʻano ʻōpala he thrombosis hohonu (DVT) hohonu. Haki ke kōkō o ke koko a hele i nā akemāmā kahi i waiho ai.

ʻO nā kumu maʻamau ʻole e hoʻopili ʻia me nā ʻōhū lewa, nā momona momona, nā wai amniotic, a i ʻole nā ​​ʻōpala o nā parasite a i ʻole nā ​​ʻula tumora.

Loaʻa paha ʻoe i kēia ʻano inā loaʻa iā ʻoe a i ʻole kou ʻohana ka moʻa koko o ke kaola a i ʻole kekahi mau maʻi ʻōpala. Hiki i kahi embolus pulmonary:

• Mahope o ka hanau keiki
• Ma hope o ka puʻuwai puʻuwai, ʻoki ʻana o ka puʻuwai, a i ʻole ka hahau
• Ma hope o nā hōʻeha nui, nā wela, a me nā haki o nā pūhaka a i ʻole ka iwi o ka ʻūhā
• Ma hope o ke kaha ʻana, ka iwi maʻamau, ka hui pū, a me ka ʻoki ʻana o ka lolo
• I ka wā a ma hope paha o kahi lele lōʻihi a kaʻa paha
• Inā loaʻa ʻoe i ka maʻi ʻaʻai
• Inā lawe ʻoe i nā lāʻau hoʻomalu hānau a i ʻole ka estrogen therapy
• Hoʻomaha hoʻomaha moe lōʻihi a noho paha i kahi kūlana no ka manawa lōʻihi

Nā maʻi e alakaʻi ai i ke kahe o ke koko:

• Nā maʻi o ka ʻōnaehana pale e paʻakikī i ke kōkō ʻana o ke koko.
• ʻO nā maʻi hoʻoilina e hoʻonui ai i ke koko. ʻO kekahi ʻano maʻi ʻo ka antithrombin III ka hemahema.

ʻO nā ʻōuli nui o kahi pulmonary embolism me ka ʻeha o ka umauma i lilo i kekahi o kēia mau mea:

• Ma lalo o ka umauma a ma kekahi ʻaoʻao
• Kaha a ʻāʻā paha
• Puhi ahi, ʻehaʻeha, a kūpilikiʻi paha, kaumaha nui
• Piʻi pinepine ka maikaʻi me ka hanu hohonu
• Hiki paha iā ʻoe ke kūlou a paʻa i kou umauma i ka pane ʻana i ka ʻeha

Hiki i nā ʻōuli ʻē aʻe ke:

• Ka paupauaho, ʻālohilohi, a maʻule paha
• Low pae oxygen ma ke koko (hypoxemia)
• Ka hanu wikiwiki ʻana a i ʻole ke kani ʻana
• Ka helu puʻuwai wikiwiki
• Ke hopohopo nei
• ʻEha wāwae, ʻulaʻula, a pehu paha
• Kaomi haʻahaʻa
• Hū koke, maliʻa paha i ke koko a i ʻole nā ​​mucus koko
• Ka hanu ʻana e hoʻomaka koke i ka hiamoe a i ʻole ka hoʻoikaika ʻana
• Hewa papa haʻahaʻa
• ʻO kaʻili Bluish (cyanosis) - emi iki

E hana ka mea mālama ola i kahi hoʻokolohua kino a nīnau e pili ana i kāu mau hōʻailona a me ka mōʻaukala olakino.

E hana ʻia paha nā hoʻokolohua lab e hiki ai ke ʻike i ke ʻano o ka hana a kou mau māmā.

• Nā ʻenekini koko arterial
• Pulse oximetry

Hiki i nā hoʻokolohua kiʻi ʻana aʻe ke kōkua i ka hoʻoholo ʻana ma hea kahi o ke koko.

• Pākuʻi x-ray
• CT angiogram o ka umauma
• Pulmonary ventilation / perfusion scan, i kapa ʻia hoʻi he scan V / Q
• CT angiogram pulmonary

Nā hoʻokolohua ʻē aʻe i hana ʻia e hoʻopili ʻia:

• Scanner CT pahu
• Hōʻoia ke D-dimer
• ʻO ka hōʻike ultrasound Doppler o nā wāwae
• ʻEchocardiogram
• ECG

E hana ʻia paha nā hoʻokolohua koko e nānā inā loaʻa ka manawa nui i ke kāpili ʻana o ke koko, e like me:

• Nā Antibroidolipid nā mea ʻohā
• Ke hoʻāʻo nei i nā genetic e nānā i nā loli i hiki ke hoʻomohala i nā huehue koko
• Lupus anticoagulant
• Protein C a me nā pae protein S

Pono kahi embolus pulmonary i ka mālama koke. Pono ʻoe e noho i ka haukapila.

• E loaʻa iā ʻoe nā lāʻau e lahilahi ai ke koko a hoʻoliʻiliʻi hoʻi i ka hana ʻana o kou koko i nā clots hou aʻe.
• I nā hihia o ke koʻikoʻi, hoʻoweliweli pulmonary embolism, hiki i ka mālama ʻana ke hoʻopili i ka hoʻopau ʻana i ka pūpū. Kapa ʻia kēia thrombolytic therapy. E loaʻa iā ʻoe nā lāʻau e hoʻonā i ke kāʻei.

Inā pono ʻoe e noho i ka haukapila ʻaʻole paha ʻoe e pono e lawe i nā lāʻau i ka home e lahilahi i ke koko.

• Hāʻawi ʻia ʻoe i nā pila e lawe a i ʻole pono ʻoe e hāʻawi iā ʻoe iho i nā injection.
• No kekahi mau lāʻau, pono ʻoe i nā hoʻokolohua koko e nānā i kāu hana.
• Pehea ka lōʻihi e pono ai ʻoe e lawe i kēia mau lāʻau i ka hapanui o ke kumu a me ka nui o kou koko kō.
• E kamaʻilio kāu mea lawelawe iā ʻoe e pili ana i ka makaʻu o ke kahe ʻana o ke kahe ke lawe ʻoe i kēia mau lāʻau.

Inā ʻaʻole hiki iā ʻoe ke lawe i nā mea lahilahi o ke koko, manaʻo paha kāu mea hāʻawi i ka ʻoki ʻana e hoʻonoho i kahi hāmeʻa i kapa ʻia he kānana vena cava inferior (kānana IVC). Hoʻokomo ʻia kēia hāmeʻa i ke aa nui i loko o kou ʻōpū. Mālama ʻo ia i nā ʻōpala nunui mai ka hele ʻana i nā kīʻaha koko o nā akemāmā. I kekahi manawa, hiki ke kau ʻia kahi kānana kūlohelohe a lawe ʻia ma hope.

Pehea ke ola maikaʻi o ke kanaka mai kahi pulmonary embolus hiki ke paʻakikī ke wānana. Pili pinepine ia i:

• He aha ke kumu o ka pilikia ma kahi mua (e laʻa me, maʻi ʻaʻai, ʻoki kino nui, a i ʻole ʻeha)
• ʻO ka nui o ke kōkō ʻana o ke koko i nā akemāmā
• Inā hoʻonā ke koko i ka manawa

Hiki i kekahi poʻe ke hoʻomohala i nā pilikia lōʻihi o ka naʻau a me ka lung.

Hiki ke make i ka poʻe me ka embolism pulmonary koʻikoʻi.

E hele i ka lumi pilikia a kāhea paha i ka helu pilikia kūloko (e like me 911), inā he ʻōuli kou o ka pulmonary embolus.

Hoʻopaʻa ʻia nā mea lahilahi e kōkua i ka pale ʻana i ka DVT i ka poʻe i loaʻa i ka pilikia nui, a i ʻole nā ​​mea e ʻoki poʻokela ʻana i ka pilikia nui.

Inā he DVT kāu, e kuhikuhi ana kāu mea hāʻawi i nā lāʻau kaomi. Hōʻaʻahu iā lākou e like me ke kauoha. E hoʻomaikaʻi lākou i ke kahe o ke koko i kou mau wāwae a hōʻemi i kou makaʻi no ke kahe o ke koko.

Ke neʻe pinepine nei i kou mau wāwae i ka wā o nā huakaʻi mokulele lōʻihi, nā huakaʻi kaʻa, a me nā hanana ʻē aʻe āu e noho ai a i ʻole ke moe ʻana i lalo no nā wā lōʻihi hiki ke kōkua i ka pale ʻana iā DVT. Pono paha ka poʻe i ke kūlana kiʻekiʻe loa no ke kahe o ke koko i nā pana o ka mea lahilahi o ke koko i kapa ʻia heparin ke lele lākou ʻoi aku ka lōʻihi ma mua o 4 mau hola.

Mai puhi. Inā puhi ʻoe, haʻalele. ʻO nā wahine e lawe ana i ka estrogen e pono e hoʻōki i ka puhipaka. Hoʻonui ka puhihihi i kou makaʻu i ka hoʻomohala ʻana i ke koko.

ʻO ka thromboembolism Venous; Pāʻū koko; Koko koko - māmā; Embolus; Tumor embolus; Embolism - pulmonary; DVT - pulmonary embolism; Thrombosis - pulmonary embolism; ʻO ka thromboembolism pulmonary; PE

• Trombosis o ka aa hohonu - hoʻokuʻu
• Lawe iā warfarin (Coumadin, Jantoven) - he aha e nīnau aku ai i kāu kauka
• Lawe iā warfarin (Coumadin)

• Lungs
• ʻŌnaehana hanu
• Embolus pulmonary

ʻO Goldhaber SZ. Emperor pulmonary. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: kahi puke o ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 84.

Kline JA. ʻO ka pulmona embolism a me ka thrombosis hohonu o ke aʻa. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 78.

Morris TA, Fedullo PF. ʻO ka thromboembolism pulmonary. I: Broaddus VC, Mason RJ, Ernst JD, et al, eds. ʻO Murray a me Nadel's Textbook of Respiratory Medicine. ʻElua huaʻōlelo Piladelapia, PA: Elsevier Saunders; 2016: chap 57.