One of geriatric emergencies

1. Siti Nurul Afiqah binti Johari (10-6-95)

3. Clinical picture

4. Investigations
i. Laboratory:
• ABG: might be normal, type 1 RF, severe hypoxemia,
mild hypocapnea
• D-dimer
ii. ECG: Sinus tachycardia, Rt BBB,
ST-T abnormalities
ii. Radiological:
• Chest X-ray
• CTPA
• V/Q lung scan

5. What to consider in geriatrics?
• Sensitivity to the anticoagulant effect of a given
dose increases with age
• Polypharmacy (include self med) increases risk of
drug interactions which alter oral anticoagulant
effect or which increase the risk of bleeding
• Increased prevalence of concurrent or
intercurrent illness
• Decreased compliance or decreased access to
monitoring

6. Prophylaxis
• Patients who undergone
surgery, 4-6 weeks of
LMWH or UFH
• Graduated compressive
stockings and pneumatic
compression devices
Treatment
• LMWH prevents clot formation
and extension given SC 1/2x a
day
• Long term anticoagulation
after discharge is warfarin
• Thrombolytic therapy with
massive PE who have
significant pulmonary HTN,
obstruction of multiple
segments of pulmonary
circulation, rt ventricular dysfx
or systemic hypotension
• IVC filter in special
circumstances