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Vol. 46. Issue S7.
Neumología de urgencias
Pages 31-37 (October 2010)
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Vol. 46. Issue S7.
Neumología de urgencias
Pages 31-37 (October 2010)
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Tromboembolismo pulmonar
Pulmonary thromboembolism
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93197
Adolfo Baloira Villara,
Corresponding author
adolfo.baloira.villar@sergas.es

Autor para correspondencia.
, Luis Alberto Ruiz Iturriagab
a Servicio de Neumología, Complejo Hospitalario de Pontevedra, Pontevedra, España
b Servicio de Neumología, Hospital de Cruces, Bizkaia, España
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El tromboembolismo pulmonar es una enfermedad frecuente en los servicios de urgencias. A menudo, representa un problema diagnóstico, por lo que es necesario utilizar estrategias adecuadas. La información clínica, los datos de laboratorio como el D-dímero y las técnicas de imagen, como la angiografía por tomografía computarizada, la ecografía Doppler, la gammagrafía de ventilación-perfusión o la ecocardiografía, ayudan a establecer la probabilidad diagnóstica y la gravedad del paciente. Disponiendo de toda esta información se pueden construir escalas de riesgo, como la escala PESI, con elevada sensibilidad para establecer la posibilidad de fallecimiento. El tratamiento debe iniciarse rápidamente con heparina, en general de bajo peso molecular. Si la situación es de riesgo alto puede estar indicado el uso de fibrinolíticos, poniendo especial atención en que no exista ninguna contraindicación. En algunos casos, puede ser necesario soporte hemodinámico.

Palabras clave:
Tromboembolismo pulmonar
Angio-TC
Heparina
Fibrinólisis
Abstract

Pulmonary thromboembolism is a frequent disease in emergency departments and often poses a diagnostic challenge that requires appropriate strategies. Clinical information, laboratory tests such as a D-dimer and imaging techniques such as computed tomography (CT) angiography, ventilation-perfusion scintigraphy or echocardiography help to establish clinical probability and the severity of the disease. With all this information, risk scores can be constructed, such as the Pulmonary Embolism Severity Index (PESI) score, which has high sensitivity in predicting mortality. Treatment should be started immediately with heparin, usually low molecular weight heparin. If the patient is at high risk, thrombolytic therapy is indicated, although possible contraindications should be thoroughly assessed. Supportive treatment may be considered in a few patients.

Keywords:
Pulmonary thromboembolism
CT angiography
Heparin
Fibrinolysis
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Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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