Directly from the ACCP Pulmonary drugs Board evaluate 2009 direction, this article covers each subject in a concise, easy-to-use structure. Use as a self-study source to organize for the pulmonary medication subspecialty board exam.
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Extra info for ACCP Pulmonary Medicine Board Review: 25th Edition
Because of the expense and invasiveness of pulmonary angiography, alternative diagnostic algorithms have been sought. Despite the lack of an independent “gold standard,” outcome studies have suggested that spiral CTPA is as accurate as pulmonary angiography. On the basis of the current evidence, the suggested approach for the diagnosis of suspected acute PE is shown in Figure 1. Figure 1. Diagnostic algorithm for acute PE. From: Tapson VF. Acute pulmonary embolism. N Engl J Med 2008; 358:1037−1052.
The recommended prophylaxis is LMWH, fondaparinux, or an oral vitamin K antagonist (international normalized ratio 2 to 3). As in moderate-risk patients, if the bleeding risk is extremely high, mechanical methods of prophylaxis should be used. Pharmacologic prophylaxis should be started as soon as the bleeding risk decreases. Although VTE is considered to be more common in surgery or trauma patients, 50 to 70% of symptomatic thromboembolic events and 70 to 80% of fatal PEs occur in nonsurgical patients.
The second line of treatment is screening of high-risk patients (as previously discussed) because it is generally believed that earlier diagnosis and treatment may improve outcomes. The third is to optimize the therapy for any related diseases, such as heart failure, hypoxemia, sleep disorders, or collagen vascular diseases. The fourth line of therapy is supportive—directed at the consequences of PAH. General measures include pneumococcal and influenza vaccinations in addition to the avoidance of pregnancy, highaltitude exposure, tobacco, and medications such as appetite suppressants, decongestants, and nonsteroidal antiinflammatory agents.
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