tep dr. yañez
TRANSCRIPT
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TOMBOEMBOLISMO
PULMONARDr. Jorge Yáñez Villaseñor
Profesor e!ar"a#e$"o #ei%i$a
i$"er$a UDE&E$fer#eaes res!ira"oriasU$ia %'iaos i$"e$si(os )**B
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Te#ario
• Sos!e%+a %l,$i%a
• E-á#e$es %o#!le#e$"arios e
i$"er!re"a%i$• Algori"#os iag$s"i%os
• E$fre$"a#ie$"o "era!/'"i%o
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0A&TORES DE RIES*O
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Es%e$arios %l,$i%os
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E-á#e$es %o#!le#e$"arios
Radiografía de tórax
Electrocardiograma
Enzimas miocárdicas
Gases en sangre arterial
Dímero –D
E%o%ariogra#aPro BNPA$gio"a% e "ra-&i$"igra#a (e$"ila%i$ !erf'si$
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TEP
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A$gio TA& e "ra-
Sensibilidad 97%
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Ele%"ro%ariogra#a
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DIMERO 1D
• Se ele(a e$ 2 – e#3arazo4 ea a(a$zaa4 e$fer#eaes
i$5a#a"orias gra(es e %'al6'ier orige$4
"ra'#a"is#o4 %á$%er4 %ir'g,a re%ie$"e4 i$far"o el#io%ario.
– Valor !rei%"i(o !osi"i(o 3a7o 8 $o soli%i"ar %'a$ola sos!e%+a %l,$i%a es al"a9.
– Valor !rei%"i(o $ega"i(o al"o 8 Des%ar"ae$fer#ea %'a$o s' res'l"ao es $or#al e$!a%ie$"es %o$ 3a7a !ro3a3ilia %l,$i%a e e#3olia9.
• .
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TEP SUBMASIVO
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&INTI*RAMA V:;
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Mar%aores e riesgo#or"alia
• Pro BNP – I$i%aor e +i!o-ia #io%ári%a < s"ress e$
!are
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Ae%'aa %orrela%i$ %o$ %o#!li%a%io$es
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EN0RENTAMIENTO&LINI&O
Pro3a3ilia iag$os"i%aPro3a3ilia e falle%er
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Algori"#o &+ris"o!+er
• Si#!li=%a @ells – #as
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• Pos"erio#e$"e – Di#ero C D
– A$gio"a% "ora-
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Sos!e%+a TEP)e#oi$a#ia
es"a3le
Ba7a Al"a
Di#ero C D 819Des%ar"a
iag$os"i%oA$gioTA&
TEP 819 TEP 89
DD 89
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TEP 2 o'"%o#es•PAS F•Dis#i$'%io$ F##)g !or GH#i$'"os
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Tra"a#ie$"o
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&á$%er Tro#3o=lia
TEP re%'rre$"e
N'e(os a$"i%oag'la$"esorales
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)e!ari$a soi%a
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)e!ari$a 3a7o !eso#ole%'lar
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TROMBOLISIS
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0ILTRO VENA &AVA
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