Department of Cardiology, Veterans Affairs Healthcare System, San Juan, Puerto Rico.
Department of Internal Medicine, Veterans Affairs Healthcare System, San Juan, Puerto Rico.
P R Health Sci J. 2022 Jun;41(2):104-106.
Syncope is a common cause of emergency department visits. Physicians must scrutinize for life-threatening causes to avoid patient morbidity and mortality. Clinical decision rules are used to stratify risks and guide the course of action, including the need for further testing. This is the case of a 83-year-old man was brought to the emergency department after a 5-minute episode of sudden loss of consciousness. Vital signs showed hypotension and physical examination was unremarkable. Despite Wells score of 0, clinical suspicion for pulmonary embolism persisted, for which further testing was pursued. D-dimer was elevated at 13.77 mcg/mL and a chest computed tomography with angiography showed an extensive bilateral pulmonary embolism involving the distal right and left main pulmonary arteries. He was started on full-dose anticoagulation. This case exemplifies the need of high clinical suspicion along with the importance of applying predictive scores for diagnosing unusual causes of syncope.
晕厥是急诊科就诊的常见原因。医生必须仔细检查是否存在危及生命的原因，以避免患者出现发病率和死亡率。临床决策规则用于分层风险并指导治疗方案，包括是否需要进一步检查。这是一位 83 岁男性的病例，他在突发意识丧失 5 分钟后被送往急诊科。生命体征显示低血压，体格检查无明显异常。尽管 Wells 评分为 0，但仍怀疑为肺栓塞，因此进行了进一步检查。D-二聚体升高至 13.77 mcg/mL，胸部 CT 血管造影显示广泛的双侧肺动脉栓塞，累及右和左主肺动脉的远端。他开始接受全剂量抗凝治疗。本例说明了需要高度的临床怀疑，以及应用预测评分诊断晕厥不常见原因的重要性。
