Ms. Huang has just retired and is at home with her daughter-in-law!
Usually the body is OK, that is, a little high blood pressure, eating antihypertensive drugs, blood pressure control is not bad, long-term maintenance between 120-130/70-80mmHg.
In the morning, After Ms. Huang fed her little grandson, she suddenly felt shortness of breath, chest tightness, and panic. She thought there was something wrong with her blood pressure, so she quickly measured her blood pressure and found that her blood pressure was 90/60mmHg. After the first measurement, she suspected it was a mistake because her blood pressure had never been so low. After measuring again, her blood pressure is still about 90/60mmHg, and her heartbeat is particularly fast, with a heartbeat of 110 beats per minute, while her usual heartbeat is only 70 beats per minute, up to 80 beats per minute.
This can frighten Ms. Huang, quickly called her daughter, saying that her blood pressure is low, chest tightness and breath, and her daughter said to lie down quickly, don't move, it may be heart disease, maybe heart attack.
The daughter immediately hit 120 and rushed home at the same time.
After 120 rushed home, an electrocardiogram was done and did not find the manifestation of myocardial ischemia, let alone an electrocardiogram like myocardial infarction. Blood pressure was then measured at 87/56 mmHg, a small dose of dopamine infusion was given, and the heart rate was measured 120 times per minute, and the patient was quickly carried to the 120 cart and taken to the hospital.
After arriving at the hospital, we were already waiting in the emergency room for consultation, I took a look at the ECG and told the emergency nurse to review the ECG.
ECG can be seen: I-lead S wave, III-lead Q wave + T wave, heart rate 122 beats / min.
This kind of ECG is a typical S1Q3T3 ELECTROCARDI, our professional doctors have read it, at this time, it is highly suspected that there is a thrombosis in the pulmonary blood vessels, called pulmonary embolism, also called pulmonary infarction.
The most common we hear about are myocardial infarction and cerebral infarction. Myocardial infarction is the heart's arterial blood vessels are blocked by blood clots, cerebral infarction is the cerebral blood vessels are blocked by blood clots, then this pulmonary embolism or lung infarction, that is, the blood vessels of the lungs are blocked by blood clots.
According to the performance of the ECG, combined with the patient's sudden rapid heart rate, low blood pressure, and blood oxygen saturation of 86% (the blood oxygen saturation of healthy people is generally 95% to 100%). ）。 Then you can diagnose acute pulmonary embolism, immediately and accurately dissolve the thrombolysis, inform the family of the condition, sign a notice of critical illness and a thrombolysis consent.
After 2 hours of thrombolysis, the patient's heart rate gradually slowed down from 120 to 100 beats, the patient's blood pressure gradually rose from 90/60 mmHg to 105/70 mmHg, and the patient's blood oxygen saturation rose from 86% to 93%. Patients' chest tightness, shortness of breath and shortness of breath and other feelings were significantly improved.
Ms. Huang's daughter was very grateful and said that she would definitely send a pennant to express her gratitude.
1. What is pulmonary embolism?
As we mentioned above, pulmonary embolism, also known as pulmonary infarction, is a blood vessel blocked by a blood clot in the lungs.
After the blood vessels in the lungs are blocked, the function of the lungs is reduced, and the main function of the lungs is to breathe and provide oxygen to the human body. When pulmonary embolism occurs, lung function decreases, then we feel hypoxia.
Blood clots in the lungs are generally not produced by the lungs themselves, but from other parts of the body, such as common venous thrombosis of the lower limbs, cancer thrombosis caused by tumors, and amniotic fluid embolism when giving birth, which are the main causes of pulmonary embolism. Of course, there are also some unexplained blood clots that fall off, which can also cause pulmonary embolism.
2. What are the typical manifestations of pulmonary embolism?
Since pulmonary embolism is a blockage of blood vessels in the lungs and a decrease in lung function, the most typical manifestation is lack of oxygen: chest tightness, breathing difficulties, fatigue, and sweating.
Vital signs may show decreased blood pressure, increased heart rate, and decreased oxygen saturation.
This Huang lady is a very typical symptom of pulmonary embolism: I began to feel chest tightness, shortness of breath, low blood pressure measurement, fast heart rate, and low blood oxygen saturation when I went to the hospital to check.
Some patients also present with chest pain and cough, or prostration, pallor, cold sweat, etc., and even extreme anxiety, fatigue, nausea, convulsions and even coma, and will also manifest as syncope or even sudden death. The analysis of the Chinese pulmonary thromboembolism registration study showed that 10% of patients with pulmonary embolism had syncope as the first symptom.
3. How to diagnose pulmonary embolism?
When a person has the above manifestations, we have to suspect pulmonary embolism.
At this time, an electrocardiogram is required, which can not only confirm myocardial infarction, but also diagnose pulmonary embolism. A typical ECG of pulmonary embolism is characterized by lead I S waves, lead III Q waves + T waves.
At the same time, you can test whether the D2 polymer is high by blood draw, most of the pulmonary embolism D2 polymer is high, and it is also necessary to draw arterial blood gas analysis to see if the artery is hypoxic.
The most accurate test is called pulmonary vascular enhancement CT or pulmonary angiography.
4. How to rescue pulmonary embolism?
Once pulmonary embolism is confirmed, the root risk is stratified, and the decision is made whether to thrombolysis, low-risk groups, hospitalization observation, anticoagulation can be used; high-risk groups, like this Huang lady, need immediate thrombolysis rescue.
At the same time, find the source of the blood clot as much as possible to prepare for the next step of preventing pulmonary embolism.
5. How to prevent pulmonary embolism?
Pulmonary embolism is a blood clot that originates in different parts, so prevention cannot be talked about uniformly.
For example, amniotic fluid embolism can not be effectively prevented at present, early detection and early rescue; long-term bedridden patients, mainly turn over and pat their backs, auxiliary activities; we can move, to adhere to the activity, to avoid slow blood flow, to avoid blood clots; people with clear blood clots, need formal treatment, to prevent thrombosis shedding.
In short, pulmonary embolism is one of the critical diseases, and acute myocardial infarction and aortic dissection are collectively known as chest pain triad, when we have hypotension, rapid heart rate, hypoxia and other manifestations, we must first think about whether it is pulmonary embolism!