Trombembolism

Question 1

Trombembolism definitie

Answer 1

Ocluzia patului arterial pulmonar
Prin trombi grasime lich amniotic
Consecinta rapida e ivd acuta

Question 2

Cum vine un embol

Answer 2

Din curc sistemica=>cava=>ad=>vd=>artera pulm=>arteriole pulm=> RETROGRAD PRESIUNE CRESCUTA=>IC DREAPTA!!!

Question 3

Patogeneza tvp

Answer 3

Staza
Hipercoagulabilitate
Disf endoteliala

Question 4

Facturi majori predispozanti trombembolism

Cresc de 10 ori sansa

Answer 4

Protezare sold genunchi
Internare pt ima fia in ultimele 3 luni
Ic in ultimele 3 luni
Fractyra sold picior
Antecedente tbv
TRAUMA MAJORA
LEZIUNI MEDULARE

Question 5

Factori medii predispozanti tvp

2-9 ori

Answer 5

Operatie artroscopica genunchi
Bolia autoimune
Transfuzii sange
Linii venoase centrale
Chimioterapie
Ic sau iresp
Terapie cu stim eritropoetina sau substitutie hormonala
Ivf
Infectii
Malignitate
Contraceptive
Avc paralitic
POSTPARTUM
Boli inflamatorii intestinale
Tvsuperficiala
Trombofilia

Question 6

Factori slabi tvp

Answer 6

Repaus>3 zile
Dz
Hta
Imobilizare sezand
varsta
Operatii laparo
Obezitate
Sarcina/ANTEPARTUM
Vene varicoase

Question 7

Raspunsul in tep depinde de

Answer 7

Marime embol
Status cardioapulmonar preexistent
Compensare neurohormonala

Se mentine initial dar dupa intra in soc

Question 8

Teste dg in tep

Answer 8

D dimeri
Ekg

Imagistic:angioCt, scinti, ecocard

Utilitate redusa rx, rmn, angiopulm

Question 9

Ekg in tep

Answer 9

S1q3t3-mc ginn white
S1s2s3
Brd incomplet complet
Deviere ax dreapta
Tahicardie sinusala!!!!!!!!
Fia/flutter
Q in d3 si avf!!!!!!
Hipovoltaj membre
T negativ v1-v3,d3,avf(mai adant in v2 fata de v3)
Qr in v1=dilatatie de v drept

Question 10

Rx in tep

Answer 10

Normal
Condensare sau infiltrare
Atelectazie
Ascensionare hemidiafragm
Revarsat pleural
Olighemie focala(westermark)
Hiperemie pl contralarera
Dilatare artera pulm unilat
Dilatare vd-dar nu pe fata ci pe profil

Question 11

Dc apare frecv la pac spitalizati

Answer 11

Imobilizati
Se deschidrateaza
Au alte boli procoag

Question 12

Staza venoasa

Answer 12

Valve incompetente
Imobilizare prelungita
Sarcina
Interventii chir majore 
Traumatisme majore

Question 13

Leziuni ale peretilor sau efectul citokinelor tep

Answer 13

Interventii chir
Traumatisme
Ima
Arsuri
Obezitate
Cancer
Fumat excesiv

Question 14

Hipercoagulabilitate

Answer 14

Contracteptive 
Sdr antifosfolipidic
Cancer
Obezitate
Fumat excesiv

Question 15

Sdr antifosfolipidic ereditar

Answer 15

=trombofilie

Rez la prot cm
Multatie 20310
Hiperhomocisteinemie

Question 16

Tep idiopatic

Answer 16

30%

Semn de neoplazie

Question 17

Ce ins hipotens art la un pacient cu epa

Answer 17

Pai disf de vs!
Asta vine si de la miscarea paradoxLa a septului

E la risc inalt!

Question 18

Tablou clinic tep

Answer 18

Dispnee -aparitie brusca
Ortopnee
Polipnee
Sincopa-hipoperfuzie(isi revine ca intra mecanisme compensatorii) deci face o insuf card dr acuta(risc inalt)
Durere pleuritica
Durere retrosternala(poate sa fie chiar de la ischemia de vd)
Diaforeza
Tuse
Hemoptizie-infart pulmonar
Tahicardie sinusala!!!!!
Cuanoza
Edeme febra

Question 19

Dg tvp

Answer 19

Fr
Clinic
Metode img doppler venos cu vene necompresibile

Daca n are tbp nu ins ca n are tep

Question 20

D dimeri

Answer 20

Produsi de degradare
Fibrinoliza intra vasc

Predictiv negativ

Question 21

Tahicardia sinusala are un motiv

Answer 21

Sangereaza
Face febra
S a speriat
Tep

Question 22

Angioct

Answer 22

De electie
Iradiaza si folos subst ct
(Nu gravida nu ira)

Pana la artere segm

Question 23

Eco tep

Answer 23

Trastoracic
Dilatare si hipokinezie (semn mcconell)
Miscare paradox siv
Reg tricusp
Colaps vci absent
Htp!!!! Bernuli!!

Trasesof
Vad trombu

Question 24

Ores normala in ad

Answer 24

Cam 5 mmhg

Question 25

Disf vd la eco

Answer 25

Vd dilatat Apex facut mai mult din vd Sept spre vs Perete liber paralizat cu apex care se misca bn (Apexul se misca si e inp ptc se face dg dif cu ima drept unde de la vasc nu se misca nimic)

Question 26

Scinti ventilatie perfuzie

Answer 26

Radiotrasor ca sa vezi daca nu i ventilat si un trasor pt perfuzie Tipic nu se suprapun Se face la gravide, ira, intoleranta subt ct

Question 27

Sdr clinice tep

Answer 27

Masiva dispn sincopa cianoza hta Submasiva ta normala dar cu disf vd Mica ta, fct vd si biomarkeri buni Infarct pulm(durere, hemoptizie, frecatura pleurala, condensare, subfebra) Embolie paradoxala(inchidere foramen ovale patent) Embolie nontrombotica(aer, grasime, tumori, lich amniotic) Cv de pneumonie??

Question 28

Abordare dg si terapie tep

Answer 28

Faza acuta, evaluare rusc de recurenta, ev etiologie

Question 29

Evaluare prognostica initiala

Answer 29

Instabilitate hemodinamica-risc inalt Risc intermediar:n are instab hemodin, index pesi sau spesi pt a dif intrebintermediR inalt si intermediar scazut +img vs si troponina

Question 30

Risc inalt trp

Answer 30

Instab hemodinamica

Question 31

Risc mic sau internediar tep

Answer 31

Fara instab hemodinamica

Question 32

Insta hemodin

Answer 32

Soc cardiogen Are nev de resuscitare Soc obstructiv(tens sub 90 si end organ hipoperfusion) Hipotensiune persostenta (t<90 sau scadere cu mai mult de 40)

Question 33

Pesi cu cat e mai mare e risc mai mare

Answer 33

``` Varsta Sex Cancer Ic cronica Boala pulm cronica Tahicardie Tens sist <100 Polipnee Temp <36 Status mental alterat Oxihemoglobina <90 ```

Question 34

Abordare pacient cu instab hemodinamica

Answer 34

Tte=> insuf vd => Daca pot fac ct si pun dg Daca nu incep trat

Question 35

Terapie tep

Answer 35

Reperfuzie:tromboliza embolrctomie terapie percutana Trat disfunctiei de vd(suport volemic, norepinefrina, dobutamina, exigenare prin mb extracorporeala) Anticoagulare Insertie de filtru in cava

Question 36

Abordare risc intermediar

Answer 36

Instab hemodinamic nu e Probabilitate mica: D dimeri Angioct Probabilitate inalta: Angioct

Question 37

Probabilitatea clinica de embolie pulm geneva

Answer 37

``` Antecedente de tep Frecv cardiaca75-95:>95) Operatie in ultima luna Hemoptizii Cancer activ Durere mb inn Edem Varsta ```

Question 38

Tromboliza

Answer 38

Risc inalt si intermediar inalt | 2sapt de la inc simpt

Question 39

Anticoagulare tep

Answer 39

La toti Previne extensia lor Risc inalt: hep nefractionala Risc non unalt: hep greutate mica sau fondaparinux +aco antivit k 1:44=>1:58