醫學筆記匯整 ED Notes

Pulmonary embolism 肺栓塞
基本上這些 Venous thromboembolism (PE, DVT) 的治療
最核心的就是 systemic anticoagulation 抗凝血治療
- Unfractionated heparin (80 units/kg bolus, then 18 units/kg/h infusion)
- Low-molecular-weight heparin (Enoxaparin 1 mg /kg SC Q12H)
- Dabigatran, Apixaban, Rivaroxaban, Edoxaban

另一個選擇是在嚴重的病人考慮 Fibrinolytic treatment 溶栓治療
- Alteplase
- Streptokinase
- Urokinase

要考慮 Fibrinolytic treatment 溶栓治療的病人
基本上就是嚴重不穩定的病人, 而且沒有溶栓治療治療 Contraindication
Contraindication 基本上就是腦出血, 嚴重外傷, metastatic cancer 這些

嚴重不穩定的病人是
- Cardiac arrest 心跳休止
- Hypotension (SBP >90 mm Hg) 低血壓
- Respiratory failure 呼吸衰竭 (低血氧, 呼吸功增加)
- Evidence of right-sided heart strain 右心損傷證據
  on echocardiography or elevated levels of troponin T or I

當然還有 catheter-directed fibrinolysis, 甚至 surgical embolectomy 這些治療選擇