Second Author pada Abstrak “Detection of Acute Pulmonary Embolism in Post Orthopedic Surgery Using Revised Geneva Score and Well Score : A Case Report”
Ditampilkan sebagai Moderated Poster pada 31st Weekend Course on Cardiology (WECOC) 2019
Detection of Acute Pulmonary Embolism in Post Orthopedic Surgery Using Revised Geneva Score and Well Score : A Case Report.
P.R. Indrisia1, A.I. Nurudinulloh1 , H. Priyatna2, P. Rahasto2, M.C. Amira2
1General Practitioner, Tangerang General Hospital, Banten
2Cardiologist, Departemen of Cardiology and Vascular Medicine, Tangerang General Hospital, Banten
Introduction:
Acute pulmonary embolism (PE) is a life threatening condition with high mortality rate. PE is difficult to determined. It can be asymptomatic or the presentation of PE may be lead to sudden death. Gold standard diagnosis of acute PE is CT scan. In the developing country, some region has own limitations, however in fatal case, patient should be treated immediately.
Illustration:
A 65-years old male in orthopaedic ward complained acute dyspnea after first physiotherapy session. He denied had chest pain. He became agitated. He had been undergone ORIF surgery 2 days before because of closed hip fracture. He had not medical history of heart problems, hypertension, diabetes, or kidney problems. However he have been smoke for about 20 years. Physical examination showed hemodynamic instability, Blood pressure was 80/ pulse, heart rate (HR) 172/ minutes, Respiratory rate was 42/ minutes and saturation was 87% room air. There were not rhonci or rales in lung, normal heart sound, no swollen leg or elevated JVP. Electrocardiogram showed sinus tachycardia 176/minute, ST depression at II,III, AVF. We highly suspicious that patient had acute PE, Wells’ score was calculated and the total is 6, and 10 for Revised Geneva score. . CT scan was unavailable those time and he was too unstable to be transported to echocardiography room, we decided to treat him as acute PE immediately. He showed improvement. Later, echocardiography showed Mc Connel sign, dilatation of RA and RV, normal global kinetic of LV, EF 65%, TR moderate and high probability PH.
Discussion:
Pulmonary embolism is a life threatening condition that should be promptly recognized. The risk of PE is higher for those eho took surgery such as orthopedic hip and knee surgery. PE can be asymptomatic or acute manifestation. Based on ESC guideline, CT scan is the gold standard for diagnosis for patient suspected PE based on Geneva and well score, if CT unavailable, echocardiography should be performed. In this case, patient was unstable, we found that revised Geneva score and Well score are very useful as predictors.
Conclusion:
Revised Geneva and Well score can be useful in limitation condition. Life-threatening presentation with highly suspicious PE can be classified and possible treated immediately
Keywords: pulmonary emboli, Well’s score, Revised Geneva score
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