Trott Terren, Bowman Jason
Department of Emergency Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40503, USA; Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40503, USA.
Department of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, 800 Rose Street, Lexington, KY 40503, USA.
Emerg Med Clin North Am. 2022 Aug;40(3):565-581. doi: 10.1016/j.emc.2022.05.008. Epub 2022 Jul 8.
Pulmonary embolism is a challenging pathology commonly faced by emergency physicians, and diagnosis and management remain a crucial skill set. Inherent to the challenge is the breadth of presentation, ranging from asymptomatic pulmonary emboli to sudden cardiac death. Diagnosis and exclusion have evolved over time and now use a combination of clinical decision calculators and updates to the classic d-dimer cutoffs. Management of pulmonary emboli revolves around appropriate anticoagulation, which for most of the patients will comprise newer oral agents. However, there remains a substantial degree of practice variation and ambiguity when it comes to higher risk patients with submassive or massive pulmonary emboli.
肺栓塞是急诊医生常面临的具有挑战性的病症，其诊断和管理仍然是一项关键技能。这一挑战的内在因素在于临床表现的多样性，从无症状肺栓塞到心源性猝死。随着时间推移，诊断和排除方法不断演变，现在结合了临床决策计算器以及对经典D - 二聚体临界值的更新。肺栓塞的管理主要围绕适当的抗凝治疗展开，对于大多数患者而言，这将采用新型口服药物。然而，对于高危的亚大面积或大面积肺栓塞患者，在治疗实践上仍存在很大差异和不确定性。
