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Pulmonary Embolism Definition:Pulmonary embolism is an obstruction of a blood vessel in the lungs, usually due to a blood clot, which blocks a coronary artery. Description Pulmonary embolism is a fairly common condition that can be fatal. According to the American Heart Association, an estimated 600,000 Americans develop pulmonary embolism annually; 60,000 die from it. As many as 25,000 Americans are hospitalized each year for pulmonary embolism, which is a relatively common complication in hospitalized patients. Even without warning symptoms, pulmonary embolism can cause sudden death. Treatment is not always successful. Pulmonary embolism is difficult to diagnose. Less than 10% of patients who die from pulmonary embolism were diagnosed with the condition. It occurs when emboli block a pulmonary artery, usually due to a blood clot that breaks off from a large vein and travels to the lungs. More than 90% of cases of pulmonary embolism are complications of deep vein thrombosis, blood clots from the leg or pelvic veins. Emboli can also be comprised of fat, air, or tumor tissue. When emboli block the main pulmonary artery, pulmonary embolism can quickly become fatal. Causes and symptoms Pulmonary embolism is caused by emboli that travel through the blood stream to the lungs and block a pulmonary artery. When this occurs, circulation and oxygenation of blood is compromised. The emboli are usually formed from blood clots but are occasionally comprised of air, fat, or tumor tissue. Risk factors include: prolonged bed rest, surgery, childbirth, heart attack, stroke, congestive heart failure, cancer, obesity, a broken hip or leg, oral contraceptives, sickle cell anemia, congenital coagulation disorders, chest trauma, certain congenital heart defects, and old age. Common symptoms of pulmonary embolism include:
Less common symptoms include:
In some cases there are no symptoms. Diagnosis Pulmonary embolism can be diagnosed through the patient's history, a physical exam, and diagnostic tests including chest x ray, lung scan, pulmonary angiography, electrocardiography, arterial blood gas measurements, and leg vein ultrasonography or venography. A chest x ray can be normal or show fluid or other signs and rule out other diseases. The lung scan shows poor flow of blood in areas beyond blocked arteries. The patient inhales a small amount of radiopharmaceutical and pictures of airflow into the lungs are taken with a gamma camera. Then a different radiopharmaceutical is injected into an arm vein and lung blood flow is scanned. A normal result essentially rules out pulmonary embolism. A lung scan can be performed in a hospital or an outpatient facility and takes about 45 minutes. Pulmonary angiography is the most reliable test for diagnosing pulmonary embolism but it is not used often, because it carries some risk and is expensive, invasive, and not readily available in many hospitals. Pulmonary angiography is a radiographic test which involves injection of a pharmaceutical "contrast agent" to show up the pulmonary arteries. A cinematic camera records the blood flow through the lungs of the patient, who lies on a table. Pulmonary angiography is usually performed in a hospital's radiology department and takes 30 minutes to one hour. An electrocardiograph shows the heart's electrical activity and helps distinguish pulmonary embolism from a heart attack. Electrodes covered with conducting jelly are placed on the patient's chest, arms, and legs. Impulses of the heart's activity are traced on paper. The test takes about 10 minutes and can be performed in a physician's office or hospital lab. Arterial blood gas measurements can be helpful, but they are rarely diagnostic for pulmonary embolism. Blood is taken from an artery instead of a vein, usually in the wrist and it is analyzed for oxygen, carbon dioxide and acid levels. Venography is used to look for the most likely source of pulmonary embolism, deep vein thrombosis. It is very accurate, but it is not used often, because it is painful, expensive, exposes the patient to a fairly high dose of radiation, and can cause complications. Venography identifies the location, extent, and degree of attachment of the blood clots and enables the condition of the deep leg veins to be assessed. A contrast solution is injected into a foot vein through a catheter. The physician observes the movement of the solution through the vein with a fluoroscope while a series of x rays are taken. Venography takes between 30-45 minutes and can be done in a physician's office, a laboratory, or a hospital. Radionuclide venography, in which a radioactive isotope is injected, is occasionally used, especially if a patient has had reactions to contrast solutions. Most commonly performed are ultrasound and Doppler studies of leg veins. Treatment Patients with pulmonary embolism are hospitalized and generally treated with clot-dissolving and clot-preventing drugs. Oxygen therapy is often needed to maintain normal oxygen concentrations. For people who can't take anticoagulants and in some other cases, surgery may be needed to insert a device that filters blood returning to the heart and lungs. The goal of treatment is to maintain the patient's cardiovascular and respiratory functions while the blockage resolves, which takes 10-14 days, and to prevent the formation of other emboli. Thrombolytic therapy to dissolve blood clots is the aggressive treatment for very severe pulmonary embolism. Streptokinase, urokinase, and recombinant tissue plasminogen activator (TPA) are thrombolytic agents. Heparin is the injectable anticoagulant (clot-preventing) drug of choice for preventing formation of blood clots. Warfarin, an oral anticoagulant, is usually continued when the patient leaves the hospital and doesn't need heparin any longer. Prognosis About 10% of patients with pulmonary embolism die suddenly within the first hour of onset of the condition. The outcome for all other patients is generally good; only 3% of patients who are properly diagnosed and treated die. In cases of undiagnosed pulmonary embolism, about 30% of patients die. Prevention Pulmonary embolism risk can be reduced in certain patients through judicious use of antithrombotic drugs such as heparin, venous interruption, gradient elastic stockings and/or intermittent pneumatic compression of the legs. |
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World Trade Center Attack Memorial - September 11, 2001 Breaking News From GOD: April 17, 2006 11:24 AM
Send mail to Webmaster (at) Twin-Towers.net with questions or comments about
this web site. On Tuesday, September 11, 2001, at 8:45am New York local time, One World Trade Center, the north tower, was hit by a hijacked 767 commercial jet airplane, loaded with fuel for a trans-continental flight. Two World Trade Center, the south tower, was hit by a similar hijacked jet 18 minutes later at 9:03am. (In separate but related attacks, the Pentagon building near Washington D.C. was hit by a hijacked 757 at 9:43am, and at 10:10am, a fourth hijacked jetliner crashed in Pennsylvania.) The south tower, WTC 2, which had been hit second, was the first to suffer a complete structural collapse at 10:05am, 62 minutes after being hit itself, 80 minutes after the first impact. The north tower, WTC 1, then also collapsed at 10:29am, 104 minutes after being hit. WTC 7, a substantial 47 story office building in its own right, built in 1987, was damaged by the collapsing towers, caught fire, and later in the afternoon also totally collapsed. The list of collapsed buildings (as confirmed by the New York Times through Saturday, 2001.0915) included all seven buildings of the World Trade center complex — including WTC 6, the U.S Customs House to the north; WTC 3, the 22 story Marriot World Trade Center hotel just west of Tower Two; and WTC 4 and 5, the Plaza Buildings to the east (although satellite images suggest much of WTC 5, the north Plaza Building, was still standing). Other nearby buildings were significantly damaged, including the St. Nicholas Greek Orthodox Church, and One Liberty Plaza, a 54 floor, 743' tall building across Church Street to the east. About 2800 people died in the attack. The recovery and site clearing process officially concluded on May 30, 2002 with 1796 people still remain unrecovered. 1.8 million tons of debris was removed from the disaster site. Yahoo! Buzz Index Overall Leaders 1. Jennifer Lopez 2. Britney Spears 3. Euro 2004 4. Harry Potter and the Prisoner of Azkaban 5. Usher 6. 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