Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1240 Psoriasis Pulmonary Embolism

complications and prognosis

■Arthritis may accompany psoriasis; treatment for the skin disease

may be effective, methotrexate or anti-TNF agents are commonly

used

■Psoriasis is a chronic disorder.

PULMONARY EMBOLISM

LESLIE H. ZIMMERMAN, MD

history & physical

History

■65–90% from leg DVTs

■Risk factors:

➣lower extremity or abdominal surgery

➣trauma

➣malignancy

➣MI

➣prior DVT

➣CHF

➣immobilization

➣hormone therapy

➣pregnancy

➣advanced age

➣thrombophilia

Signs & Symptoms

■>90% – dyspnea or tachypnea

■also: pleuritic pain, cough, leg pain or swelling (30%),

■hemoptysis, palpitations, wheezing, fever, syncope

■tachypnea, rales, tachycardia (30%), S4, increased P2 (25%), fever

(rarely > 38.5o C), DVT

tests

ABG:

■usually low PaCO2

■hypoxemia, increased A-a gradient (correlates with size)

■normal ABG does not rule out PE

Other labs:

■D-dimers: