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3 results

  • 27 - Pulmonary Embolism

  • from Section 5 - Respiratory Emergencies
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 242-254

  • Summary

    Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality and has a wide spectrum of severity, from incidental diagnosis in an asymptomatic patient to sudden refractory shock and cardiovascular collapse. Although the exact incidence remains uncertain, it is estimated that approximately 600,000 patients are diagnosed with PE annually in the United States, with mortality rates as high as 30% for patients with hemodynamic instability at presentation. A high-risk PE is one associated with hypotension or bradycardia. An intermediate-risk PE has evidence of RV strain, either by imaging or biomarkers (troponin or BNP). All others are low-risk PEs. The diagnosis of PE is often complicated by presentations that can be subtle, atypical or confounded by another coexisting disease.

  • 34 - Pulmonary embolism

  • from Section 5 - Respiratory emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 223-228

  • Summary

    This chapter discusses the diagnosis, evaluation and management of tachyarrhythmias. Ironically, the classic presentation for tachyarrhythmias mostly consists of non-specific symptoms. Patients may complain of palpitations, chest pain, lightheadedness, dyspnea, or non-specific weakness. Further evaluation will reveal a rapid heart rate on physical examination or on the electrocardiogram (ECG). Patients with unstable tachyarrhythmias present with signs and symptoms of hypoperfusion and hemodynamic compromise while still maintaining a palpable pulse. Patients who do not have a palpable pulse are deemed to be in cardiac arrest and are treated according to Advanced Cardiovascular Life Support (ACLS) guidelines. Once tachyarrhythmia is confirmed, consideration should be given to whether the arrhythmia has an underlying noncardiac etiology such as a toxic ingestion or a metabolic disturbance. The primary goal with a patient in sinus tachycardia (ST) is to treat the underlying condition rather than the tachycardia itself.