Post on 07-Feb-2018
KOMPLKASYONLAR &
LGN OLGULAR
Prof. Dr. Ender SEMZ Medical Park Gebze Hastanesi
49 yanda, erkek hasta Darda gezerken senkop ata, kafa
travmas Gtrld hastanede EKG deiiklii ve
TR: 0.14 >>> Q dalgasz MI tansyla sevk Acil servise getirildiinde genel durumu iyi,
obez, kan basnc 16-10 cmHg, kalp-akcier muayenesi normal
zgemiinde NIDDM, hipertansiyon Senkop ve kafa travmas nedeni ile acil
serviste BBT ekimi
18.02.2012
Koroner youn bakma yatrlan hastada ilk laboratuvar deerleri:
Hg: 14.4gm, lkosit: 12.250, trombosit: 207000, Tr I: 0.19, CK-MB: 9.8, Kreatinin: 0.8 mg, ALT: 45, AST: 23
Youn bakmda bulant-kusma, bilin kayb tekrar, ventrikler takikardi, kardiyovaskler arrest
Baarl canlandrmay takiben acil koroner anjiyografi
20.02.2012
ASA 300 mg, Fraxiparin 2x0.6cc, Metoprolol 50 mg, Amiodaron infzyonu, O2 tedavisi
Hg: 13gm, lkosit: 9620, trombosit: 208000,
Tr I: 0.32, CK-MB: 13, kreatinin: 1.1, ALT: 40, AST: 20, Na: 139, K: 4.5
Epigastrik duyarllk nedeni ile genel cerrahi konsltasyonu >> akut gastrit
Bradikardi ve kusmann devam etmesi, tekrarlayan arrest nedeni ile >>> Nroloji konsltasyonu: Fizik muayene normal. Kafa travmas yks nedeniyle nroirrji blmnce de grlmesi.
Acil serviste ekilen BBT >> Normal. ncelikli olarak vazo-vagal senkop dnld. Kardiyak
neden yok ise, EEG de ekilmek zere Nroloji polikliniine kontrol
Takipte genel durumu iyi, yaknmas yok. EKG Holteri ve gerekirse EF uygulanmak zere 4 gn
sonra taburcu
Taburcu olduktan 6 gn sonra tekrarlayan senkop ataklar ile tekrar yatrld.
Genel durumu iyi. Kan basnc normal, hafif takikardik ve takipneik. Kalp muayenesinde ek ses ya da frm yok.
Hg: 12.4gm, lkosit: 6930, trombosit: 288000, kreatinin: 0.9, Na: 139, K: 4.3, arteriyel kanda pH: 7.496, pO2: 52 mmHg, pCo2: 25.2 mmHg, %sO2: 90.1 HCO3: 19.5mmol
28.02.2012
28.02.2012
28.02.2012
Pulmoner emboli tans ile hastaya sistemik 100 mg tPA tedavisi uyguland (29.02.2012)
Heparin 1000 /saat Bilateral alt ekstremite venz Doppler:
Sol popliteal vende total tromboz ile uyumlu akm kayb, apta art ve kompresyona yantszlk
01.03.2012
02.03.2012
Ekosonic 106cm 40 cm endovascular device EKOS Corporation
Ekosonic 106cm 40 cm endovascular device EKOS Corporation
05.03.2012
07.03.2012 Aegisy vena cava filtresi Lifetech Scientific (Shenzhen) Co.
21.03.2012
Pulmonary Embolism Annual incidence
United States: >600,000; Europe >1,000,000
Up to 200,000 deaths in the US annually More die of PE in the US than AIDS, motor vehicle accidents & breast
cancer combined
PE categories Massive (5% of PE patients): 58% 90-day mortality rate
Patients present in hemodynamic collapse with cardiogenic shock; high early mortality rate due in part to right ventricular failure
Sub-massive (40% of PE patients): 22% 90-day mortality rate Presenting with thrombosis usually in one or both of the left and right pulmonary arteries, hemodynamic compensation and maintenance of adequate systolic arterial blood pressure albeit with right heart strain consistent with imminent right heart failure
Minor (55% of PE patients): 15% 90-day mortality rate Presenting with small clots in the distal pulmonary vessels, pleuritic chest pain, mild tachycardia and possibly hemoptysis Goldhaber SZ, Visani L, De Rosa M, et al. for ICOPER. Acute pulmonary embolism; clinical outcomes in the International Cooperative Pulmonary Embolism Registry. Lancet 1999;353:1386-1389
High Risk
Intermediate Risk
The Challenge why Thrombus Is So Difficult To Dissolve
Plasminogen receptor sites are embedded into thrombus during formation
Speed of lysis depends on ability of lytic to access plasminogen receptor sites**
Tightly wound fibrin strands prevent lytic from penetrating the thrombus, limiting access to plasminogen receptor sites
** Francis, Charles W. et al. Ultrasound Accelerates Transport of Recombinant Tissue Plasminogen Activator into Clots. Ultrasound in Medicine and Biology 21.3 (1995): 419-424.
Mechanism of Action
Ultrasound energy causes fibrin strands to thin and loosen, exposing plasminogen receptor sites
Thrombus permeability and thrombolytic penetration are dramatically increased
Ultrasonic pressure waves force drug deep into the clot and keep it there
Drug acts faster, clearing clot sooner with reduced bleeding complications, &
Ultrasound accelerated thrombolysis
WITH ULTRASOUND ENERGY
WITHOUT ULTRASOUND
ENERGY
ULTRASONIC ENERGY & THROMBOLYTIC
(Science studied over 4 decades)
No hemolysis No valve or wall damage Very low risk of embolization
Ultrasound mechanism of action
Standard Infusion Catheter
Spread of Stained t-PA
Plasma Clot Plasma Clot
Spread of Stained t-PA
EkoSonic Endovascular Device
Thrombus exposed to ultrasound absorbed 48% more t-PA in one hour, 84% more t-PA in two hours and 89% more t-PA in 4 hours than thrombus not exposed to ultrasound pressure.7
7Francis, CW, et al. Ultrasound Accelerates Transport of Recombinant Tissue Plasminogen Activator into Clots. Ultrasound in Medicine and Biology 21.3 (1995): 419-424.
Submassive Pulmonary Emboli, An Unrecognized And Often Fatal
Condition: Incidence, Diagnosis And Treatment With Ultrasonic Thrombolysis
38th Annual VEITHsymposium, New York, NY November 17, 2011
Tod C. Engelhardt, MD
Chair, Cardiovascular and Thoracic Surgery Division, East Jefferson General Hospital, Metairie, LA, USA
East Jefferson General Hospital New Orleans
Presenter Disclosure Financial:
T. Engelhardt is a consultant for EKOS Corporation
Approved Uses: The device used in this presentation has received European approval (CE Mark) for
the treatment of pulmonary embolism (PE) The device discussed in this presentation has been cleared by the US FDA for
placement in the PA for use with solutions
Unapproved/Unlabeled Uses: This presentation includes information on uses of drug and device that have not
been approved or cleared by the US FDA for PE treatment
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