8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 1/13
Pulmonary Embolism
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 2/13
Chest 2002;122;1440-1456
Introduction
• Pulmonary embolism (PE) occurs when venous
thrombosis, usually from the deep veins of the
proximal legs, travels to the lungs causing a
potential spectrum of consequences, includingdyspnea, chest pain, hypoxemia, and
sometimes death
• !eep venous thrombosis (!"#) and PE
represent a continuum of the disease entity
$nown as venous thromboembolism ("#E)
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 3/13
Chest 2002;122;1440-1456
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 4/13
P%#&'P&I'*'+
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 5/13
E-+. /0#0 or new 12223 #horax 4 ray . nonspesifi$ 5estermar$ sign (focal oligemia)
only 6 7 (tein et al)
0 *aboratory. D-Dimer has a &igh 8egative Predictive "alue
Troponin positif mar$er of &igher mortality
9 2lood +as %nalysis usually abnormaly in PE massive and
normaly in PE submassive
: ;ltrasound . sensitivity <:37 and specificity <=67
6 *ung scan . sensitivity <:67 and specificity <>7
? @-# . ensitivitas <67 dan spesifisitas <37 = elective %ngiografi is +old standard of PE
Chest 2002;122;1440-1456
Modalities Diagnostic o PE
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 6/13
!on "peciic #linical "ymptoms o PE
• -hest pain
• #achycardi
• &emoptysis• !yspnoe
• yncope
• -yanosis
"$ould be combined %it$ &Prediction rules”
To 'ncreased"peciicities
( )ell*s score or +ene,e score
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 7/13
%cute Pulmonary Embolism. Imaging in the Emergency !epartment
1adiol -lin 8 %m 99 (3>>6) 3:<A3?
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 8/13
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 9/13
"uspected PE
#$est . /ay and E#+
ssess clinicallieli$ood and
consider setting
utpatient %it$
lo% or intermediate
clinical suspicion
'npatient or $ig$
clinical suspicion
D-dimer
!ormal 3ig$
!o PE
#$est #T
!ormal Positi,e
Treat or PE!o PEDiagnosis
3>>
thromboembolism in
1P% and *P%
and its branches
4 1ay. hamtom sign (B)
E-+. /0#inverted "B9
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 10/13
E- +uidelines
PE treatment
• &aemodynamic and respiratory support
• #hrombolytic treatment
• urgical embolectomy
• &eparin anticoagulation
• 'ral anticoagulation
• "enous filter
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 11/13
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 12/13
%cute Pulmonary Embolism. Imaging in the Emergency !epartment
1adiol -lin 8 %m 99 (3>>6) 3:<A3?
8/16/2019 Pulmo Emboli-kuliah
http://slidepdf.com/reader/full/pulmo-emboli-kuliah 13/13