King M B, Harmon K R
Department of Medicine, University of Minnesota Medical School, Park Nicollet Medical Center, Minneapolis.
Clin Chest Med. 1994 Sep;15(3):561-80.
The first word of the title, unusual, captures the theme of this article. The entities discussed here: fat embolism, tumor embolism, venous air embolism, and amniotic fluid embolism, as well as other unusual embolic events are uncommon disorders that occur in specific circumscribed clinical settings. We have attempted to provide a cognitive jolt to remind the reader to consider these unusual events in appropriate differential diagnoses. No laboratory test, physical finding, or patient complaint will yield a timely diagnosis. Yet, these entities can be acutely life threatening; swift recognition is imperative. Timely and effective therapy rests on the clinical certainty that a test is not likely to establish. It is, perhaps, the greatest demand placed upon the agile clinical mind--to think of it!
标题的第一个词“异常”抓住了本文的主题。这里讨论的实体:脂肪栓塞、肿瘤栓塞、静脉空气栓塞和羊水栓塞,以及其他异常栓塞事件,都是在特定限定临床环境中发生的罕见疾病。我们试图提供一种认知冲击,提醒读者在适当的鉴别诊断中考虑这些异常事件。没有任何实验室检查、体格检查结果或患者主诉能及时做出诊断。然而,这些实体可能会急性危及生命;迅速识别至关重要。及时有效的治疗依赖于临床确定性,而这是一项检查不太可能确立的。这或许是对敏捷临床思维的最大要求——要想到它!