#pulmonary embolism

[willowreader]

Statistics don't lie It just blows my mind that people can't see or understand that COVID is a dangerous virus that can damage your body. Getting infected multiple times will have serious consequences for many.

[katbug666]

everytime i smoke a cig i think about how disappointed in me my surgeon would be. idk man. ill do it for content occasionally but don't get me twisted, im trying to avoid them! 😥

[your-witch-trial-has-expired]

Is it bad to feel angry at your dead mom cause she didn't listen to me when I told her to get something checked out. It was a blood clot. And it did kill her

Damn it if your family is worried about a medical thing like a blood clot listen for fucks sake. Your kid may be 19 but they still NEED you

And if you have a swollen area, especially if it's HARD, see a damn doctor IMMEDIATELY! Not six months later!

[ineffectualdemon]

I sometimes feel like I'm weak because I'm disabled and can't do a lot because of the pain I'm in daily

Then I remember my pulmonary embolism

TW: lots of medical talk

The normal timeline from "hey my chest hurts" to "in emergency room or dead" is hours

I walked around in agony and struggling to breathe for a WEEK

I did the SCHOOL RUN!

FOR. A. WEEK.

When it finally got bad enough A WEEK LATER and I made my husband take me to the doctor I had to walk upstairs to his offixe which left me doubled over, struggling to breathe, and in agony

Now what should have happened with a pulmonary embolism is that I should not have been able to recover from that and continue the appointment and would have been rushed to the A&E

But I DID recover!

I recovered my breathe and the agony subsided a little and so the doctor thought I had pleurisy and sent me off with oral morphine and to get a chest x-ray (but his instructions told me if the pain meds didn't help to call 999 which is what saved my life)

Anyway my point is I did all this shit which is supposed to be impossible when you have MULTIPLE BLOOD CLOTS IN YOUR LUNGS

So in summary:

I'm actually hard as fuck

[jcsmicasereports]

Coinfections and pulmonary embolism in a patient with onset of Leukemia concomitantly with COVID19- Case report by Evgenia Papakonstantinou in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

The pandemic of COVID19 is ongoing, with the treatment of neoplastic diseases to be challenging. Patients with acute leukemia are vulnerable to many pathogens due to impaired immunity coming from their disease and simultaneous chemotherapy. Although the COVID19 disease evolves milder in children, concomitant treatment for leukemia may be fatal. We present a girl with COVID19 and Escherichia Hermannii infection at diagnosis for Acute Lymphoblastic Leukemia (ALL). This child suffered bilateral pulmonary embolism after initiation of treatment. We discuss the therapeutic challenges about the initiation of chemotherapy in the context of coinfections as well as the role of COVID19 and other predisposing factors to pulmonary embolism. We found that the slight delay in the antineoplastic treatment contributed to the remission of the acute infection and did not negatively impact the initial response to the leukemia treatment. Nevertheless, the resumption of the oncological treatment should remain among our priorities.

Keywords

Acute leukemia, COVID19, Escherichia Hermannii, pulmonary embolism

Introduction

Given the immunodeficiency due to their disease and chemotherapy, patients with cancer are vulnerable to infections and COVID19 infection is really threatening. We describe a successful management of a girl diagnosed with acute lymphoblastic leukemia (ALL) and COVID19 infection concomitantly with Escherichia Hermannii sepsis. The initiation of chemotherapy was slightly postponed, due to the danger of these severe infections until blood cultures were negative for E. Hermanii. Pulmonary thrombosis was added, as COVID-19 infection predisposes for developing cardiovascular complications, while our patient was under existing predisposing factors for thrombophilia, but with appropriate management had successful outcome.

Case History

A three-year-old girl who presented with a four-day fever, rhinitis, and cough, found positive for COVID19 infection without mutation, as all her family members. She had anemia (Hb: 2.9 g/dL), neutropenia (N: 371/μL), thrombopenia (PLT: 24 K/μL) while tachypnea (RR=31/min), tachycardia (HR=146/min), fever 38.6°C, air oxygen saturation 97%, were found on examination. Empirical antimicrobial treatment with Tazobactam-Piperacillin, Amikacin, Teicoplanin, and Micafungin were given for febrile neutropenia, transfusions (blood, platelets) for myelosuppression, Remdesivir (5 mg/kg) for COVID19. Blood culture yielded Escherichia Hermannii sensitive to receiving antibiotics, but therapy was upscaled to Meropenem due to elevated CRP (109mg/l) and persistent fever 40.6°C. The antibiotic treatment lasting 14-days ceased after two negative cultures. Baseline chest computed tomography (CT) scan showed small cloudy glass spots, areas of pulmonary thickening, atelectasis. Bone marrow aspiration, with 61% blasts, set the diagnosis of pre-B acute lymphoblastic leukemia (ALL) hyperdiploid, Central Nervous System (CNS) negative. Abdominal ultrasound showed hepatomegaly and splenomegaly. Examinations for thrombophilia revealed heterozygosity for factor V Leiden. Chemotherapy started while positive for COVID according to ALLIC 2009 protocol, standard risk arm, 15 days post diagnosis. Remained in COVID clinic until two negative PCR tests. The ALL re-examination showed good prednisolone response on Day 8, complete remission on Days 15, 33. On Day 40 from the initiation of chemotherapy, she had tachypnea with a value of D-dimer elevated at 2.145 ng/mL. Chest CT revealed subsegmental pulmonary embolism on both lower lobes of the lungs. She had not high oxygen requirements, hemodynamic instability requiring intubation, and was treated with low molecular weight heparin for 3 months. She continued chemotherapy without delays, with regular weekly tests for COVID19 and without reactivations, despite the use of corticosteroids and immunosuppressive therapy.

Discussion

The management of children with haematological malignancies and Sars-Cov 2 infection remains challenging since limited data about the impact of COVID 19 in these children are available. Main goal is to optimize the oncological treatment and avoid severe Sars-Cov2 infection due to immunosuppressive therapy. The Escherichia Hermanni bacteremia1 at diagnosis increased the risk of severe complications and led to slight delay of the chemotherapy initiation. The risk of virus transmission to the immunocompromised children in our department required a structured protocol regarding nursing care and isolation techniques. According to American Society of Hematology guidelines2, (January 2021), treatment for ALL patients is individualized, especially during the induction period. Reducing chemotherapy doses is not recommended since it may alter the expected therapeutic effect on ALL, while the severity of COVID19 does not seem to be affected. According to SFCE3 (French Society Committee for fight children and adolescents' Cancers), the main threat to children with ALL remains the ALL itself, even if life-threatening infections are emerging. We slightly delayed the chemotherapy initiation and prioritized treating the viral and bacterial infection since the type of leukemia of our patient was neither potentially life-threatening nor high risk (WBC<20.000, no HR cytogenetic findings, no CNS involvement). Our concern was that the co infections could be deteriorated if we had started induction chemotherapy and corticosteroids. The limited data available suggest a significant heterogeneity regarding the time till the first negative COVID19 PCR test in oncology patients (from four to 94 days). Bisogno et al. reported 19 patients with a mean time to negative PCR of 22 days and eight patients with 19 days4. Our patient demonstrated negative PCR testing for Sars-Cov2 on the 40th day of chemotherapy. As there is no standard therapy established for paediatric oncology patients with COVID19 yet, many centers follow the treatment strategy as in adults. Bisogno et al. treated nine out of 29 oncological patients suffering from COVID19 with Ritonavir, Hydroxychloroquine, and immune plasma. The Children's Hospital of Philadelphia (CHOP) reported their experience with the plasma administration to critically ill children5. Remdesivir is RNA polymerase inhibitor recommended in children with severe Sars-Cov2 infection and underlying medical conditions, especially in the early course of illness. According to a recent meta-analysis remdesivir has the most promising evidence that improves the time to recovery6. In our patient the seven-day lasting antiviral therapy was well tolerated, without any pathological findings. The reported cases of venous thromboembolism may be related to the systemic inflammatory response or a state of hypercoagulability8. Our patient had multiple coexisting risk factors predisposing for thrombophilia, such as administration of Asparaginase, use of a central venous catheter (Hickman), and heterozygous status for the factor V Leiden. In patients with ALL and COVID19, prophylactic administration of anticoagulants may have an impact, but there are not yet standardize recommendations. We need to maintain a high index of suspicion for pulmonary embolism in patients with COVID19 and leukemia and to measure D-dimers regularly. There is need for guidelines for prophylaxis with low molecular weight heparin for pulmonary embolism in patients with COVID-19 and existing risk factors for thromboembolism. The patient was treated successfully with three- month administration of low molecular weight heparin. She continued chemotherapy without delays, with regular weekly tests for COVID19 as some authors have reported reactivations, without reactivations, despite the use of corticosteroids and immunosuppressive therapy.

Acknowledgements

Dr Pappa A., Medical Biopathologist-Microbiologist, Professor of Microbiology, Aristotle University Thessaloniki, Dr. Polychronopoulou Sofia, Coordinating Director Department of Pediatric Hematology-Oncology Agia Sofia Children’s Hospital Athens.

[serahlink]

//TW for medical talk and pics including IVS

Making a new post about this because we're in desperate need of help and I'm not sure what else to do. My father went into a heart center a state away (it was the closest they could transfer him) about a week ago because he was having breathing issues in his rib, and it turns out he has a pulmonary embolism; an infection in the artery in his lung. We aren't sure what caused it, but they were able to say it hasn't done damage yet thankfully. While he's been away, I've been trying to get commissions or any help to pay for another week but we still need 160$ to be good for another week, and we only have another full day to get it all together. We don't have anywhere to go if we can't stay here and I want my father to have somewhere to come home to.

We also need help with getting the meds he needs so the infection doesn't take over, and we will need help getting an Uber to get him back since we don't have any family or friends that could bring him back. I know it's alot to ask for, I didn't expect them to transfer him so far or for the infection to be anything serious at first. But work has been very slow and we can't do this on our own. I want to at least get a week paid for first.

My commissions are in my pinned post, or if you'd like to donate, I have a tipping function on my twitter which you can find here. Anything at all would mean alot to us in this situation. Reblogs included. Thank you.

[tspelizabeth]

A friend of mine’s friend’s sister (i know its convoluted but i know its a real person and a real gofund me is the point) needs help with medical bills

[sunkenlamb]

[blinktimes182]

TW: blood clots, life-threatening illness

In January I had what was described as a 'very large' blood clot in my lungs that caused a pulmonary embolism. Originally, they couldn't figure out the cause.

At the beginning of this week, my resting heart rate was around 15/20 BPM lower than usual, sitting around 52. Noticed swelling/slight pain in my ankle. Ended up going to urgent care.

I had an ultrasound yesterday on my right leg - turns out this is the source of my issues. I have clots running down most of the main artery, with only behind the knee being completely clear. complete DVT. I'm now being referred to a vascular surgeon.

I also have a high chance of suffering from more clots, and another pulmonary embolism.

My anxiety is through the roof. I'm constantly thinking I'm going to have a heart attack. I can't stop monitoring my HR and panicking over it.

If anyone has any previous experience with either DVT, Pulmonary embolisms, or blood clots in general and has any advice, please get in touch. I need help through this.

[nickynicole47]

I’m really not okay… 😭❤️‍🩹 My heart is exhausted 😩 How my weekend is going…

[katbug666]

Miss Kat Anon Ask Game! 😊

1. what's a random alters favorite color?

2. how many tattoos do u have?

3. how many tattoos do u want?

4. how long have u vaped?

5. what's your favorite pokémon?

6. what's your favorite pokémon you have caught in pokémon dnd?

7. what's your favorite pokémon you have encountered in pokémon dnd?

8. how many piercings do u want?

9. how long have u had a tic disorder?

10. what's a pulmonary embolism?

11. what's your favorite strain of weed?

12. what's your favorite way to smoke?

13. what's your best pokémon in pokemon go?

14. what's your favorite song right now?

15. what's your favorite band?

16. who would you love to see in concert?

17. what's a random tic you've had?

18. how long have u had a tic disorder?

19. what's your favorite ps5 game?

20. what's your favorite desktop game?

[obakanosandoitchi]

Wells Creteria for DVT and PE

[zindagi-jhandwa-firbhi-ghamandwa]

I've just been admitted to the hospital. Again.

In March last year, I was in a motorcycle accident. I ended up getting a blood clot in my leg, a condition called DVT. A piece of that clot broke off and lodged itself in 3 places in my lungs, a condition called Pulmonary Embolism.

My treatment lasted until December last year.

But now, a few days ago, I found out that my DVT is back.

And I was on my way home from work when I suddenly started to feel weird and came to the hospital instead.

I'm telling you this, Tumblr, because my friends and family freak out when I tell them anything.

I know they love me and that their freak outs are a sign of concern.

But these are the same people whose expectations I could never live up to — because of which I have anxiety and panic attacks.

ना चैन से जी सकता हूं, ना चैन से मर सकता हूं।

[mcatmemoranda]

A pt came in with a saddle PE. She had HTN and mild R heart strain, so interventional radiology decided not to remove the thrombus but to keep her on heparin gtt for now. From the intern's note:

#saddle PE #elevated d-dimer CTA from Anna Jacques consistent with saddle PE involving both pulmonary arteries and RV to LV ratio 0.9 suggesting some mild R heart strain. EKG with no ST elevation, LAD. Troponins less than 0.03, probnp 598, d-dimer 17151, and lactic 2.7. Upon transfer to PRH, troponins 15.2, probnp 617, and hypertensive 188/90. IR consulted upon transfer.

- IR consulted, per Dr. Nortin, based on hemodynamic stability and minimal R heart strain, conservative management with heparin gtt at this time with no indication for thrombectomy - stable on 2L NC - continue heparin gtt - continue ASA 81mg daily - trend troponins - trend proBNP for further RHS evaluation - EKG prn - telemetry - PT/OT - protonix ppx

[anxious-ruins]

You were all love, nothing less. I'm struggling so hard with the loss of you. You loved me no matter what, I'll never stop missing you.