醫學筆記匯整 ED Notes

1. 現在 suspect 有 DVT
2. 沒有比 PE 更像的診斷 
3. HR > 100
4. 之前有過 PE, DVT hx
5. Immobilization or surgey in 4 weeks
6. Active malignancy
7. Hemoptysis
    

Family hx is important in young age patient !!!!

 

• Dyspnea 呼吸困難
• RR 上升 很喘, Respiratory alkalosis
• Pleuritic chest pain
• Cough 
• Hemoptysis 
• Crakles
• Tachycardia
•  Syncope, HypoTN 
   

• CXR : Hampton hump
• EKG : Sinus tachy, RBBB, RAD, S1Q3T3 + V1-4 T Inversion (RV Strain pattern)
  
  
   
• ABG : hypoxemia, hypocapnia ( wash out ), increased A-a grandiant 
• D-dimer : < 500 for rule out
• Echo : RV dysfunction, D Shape
• V/Q scan
• CTA 

* 記得 Cancer workup + Thrombophilia workup 
   抗凝血 III AT III (antithrombin)
   第八因子測定 Factor VIII assa
   蛋白Ｃ Protein C, 蛋白S Protein S
   狼瘡抗凝血因子Lupus anticoagulant test
   抗磷脂抗體 Anti-phospholipid antibody-IgG