“Insuficiencia respiratoria secundaria a tromboembolismo pulmonar”

Abstract

A 66-year-old female patient, married, born in Quito and resident of Ambato, with a history of arterial hypertension diagnosed 28 years ago without treatment and as pathological family history of importance: mother died by arterial hypertension and brain hemorrhage, father died of gastric cancer. The patient has been presenting abdominal pain of moderate intensity for 6 months. This pain is located in the mesogastrio without irradiation. It also refers to weight loss since 3 months ago, which was not quantified, and the presence of dysphagia to solids and fluids is manifested on the part of the patient. Sporadic cough Access since 2 weeks ago. To the physical examination, the positive: patient conscious, oriented, FC 78x ', FR 24 x ', TA 90/60 mmHg, SO2 88%, 36.9 º C, skin and fanes slightly cyanotic, thyroid augmented in size to palpation with nodules of approximately 6 mm in left lobe, thorax with conserved expandability; Lungs decreased vesicular murmur and rales crackling at the level of pulmonary bases; Heart rhythmic cardiac noises, abdomen soft, destressable and painful to palpation of left hypocondal and During his hospital stay patient presented dyspnea and saturations ranging from 85% to 87%, to be applied laboratory tests evidenced a dimer D positive. In the scale of Wells patient presents a probability of 40.6% for thromboembolism lung, same that was confirmed in subsequent reviews by a angiotac lung. The evolution of the patient is favorable until the thirteenth day of her hospital stay, day in which she presents decay and, in the afternoon, vomit of fecaloide content, reason why it was made an interconsult with the area of general surgery who catalogued the picture as an acute obstructive abdomen, which was confirmed by image Examinations (CT scan of the abdomen). The next day of the clinical picture intensification, in other words, thirteen days after her admission, the patient presents, for four occasions, pictures compatible with a cardiorespiratory stop, and dies this very day because of the third event in which the cardiopulmonary recue was failed.

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