Aurora Lietor, Andreína Olavarría, Diego Durán, Raquel Morillo, David Jiménez and Jesús Corres.
The presence of a multidisciplinary team in addressing the pulmonary thromboembolism (TEP) gains even more importance for the start-up of the PET Codethe activation of a group of specialists to identify the best therapeutic option for the patient. Professionals know it well Ramon y Cajal Hospital, that have detailed how this initiative works, whose ultimate goal is “to be executives”.
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Simulation of activation of the TEP Code. |
This has been underlined David Jimenezhead of the Pneumology Service at the Ramón y Cajal Hospital, during the new Interhospital Conference on Pulmonology in Madrid- Ramón y Cajal Hospital, organized by Medical Writing, sponsored by the Neumomadrid Foundation and in collaboration with GSK and Oximesa Nippon Gases. During the meeting, different specialists carried out a real simulation of the operation of the TEP Code.
And it is that Ramón y Cajal is one of the first hospitals in Europe to meet telematically with the multidisciplinary team and the patient, many times outside of its schedule during the afternoon and even at night.
Diego Duran, a resident of the Pneumology Service of the Ramón y Cajal Hospital, has been in charge of presenting the case: a 26-year-old woman, without toxic habits or allergies, with the peculiarity of the use of hormonal contraceptives. When she arrives at the ER, she explains her, she manifests a chest pain one week of evolution. In addition, it has progressively developed a dyspnoea which results in not being able to make more than minimal efforts and palpitations.
The first tests carried out are a electrocardiogram and one chest x-rayhowever, it is the subsequent analysis that begins to give more relevant results that are immediately confirmed with a Angio-TC.
In this point, jesus runfrom the Emergency Service of the Ramón y Cajal Hospital already warns that the patient should be monitoreda, since it has several striking parameters such as tachycardia or right ventricular overload. As he explains, the patient in the simulation is from intermediate-high risk, so her heart rate and blood pressure must be controlled: “This is a patient with whom we must act as soon as possible and activate the PET Code to activate strategies from a therapeutic point of view.” Jiménez agrees with this prognosis, who affirms that she is a patient that “greatly worries” the professionals who treat her given her heart rate.
Lung patient profile that “concerns” specialists
“Still stable, it must be placed in an area where it can be acted upon immediately“, also emphasizes Aurora Lietor, specialist intensivist of the Intensive Medicine Service of the Ramón y Cajal Hospital. For her part, Andreina Olavarria, from the Radiology Service of the same hospital, states that the maxim of an interventional radiologist is that “patients are treated and not images”. As a radiologist, she claims to be “an advocate for imaging studies but first of all you have to see the patient. Decisions must always go in that direction, “he claims.
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“The key to the TEP Code is to be executives” |
At this point, Jiménez makes a point highlighting the importance of doing an additional test such as the transthoracic cardiac ultrasound before considering the use of advanced therapies, with associated risks.
As Durán relates, after 24-hour monitoring in the Emergency Department and hypotension was confirmed the morning after admission, an echocardiogram was performed and Activate the TEP Codein which different specialties participate, leading Pulmonology: Cardiology, Vascular Surgery, Intensive Care, Internal Medicine, Radiology and Emergency.
At this point, they are placed on the table different therapeutic options for the optimal treatment of the patientsuch as reperfusion therapy. In this sense, Jiménez warns of the importance of “agreeing among all on whether a reperfusion treatment is convenient” and Olavarría emphasizes the relevance of choosing the ideal moment in which to apply the chosen treatment. “The key to the TEP Code is to be executives“, emphasizes Jimenez.
Optimum result of PET Code activation
After activating the TEP Code and applying a fibrinolytic treatment a progressive clinical improvement is observed and after 48 hours he is transferred to a conventional hospitalization ward. Thus, after five days, she is discharged with low molecular weight heparin (LMWH). As usual, the patient attended pulmonology consultation one month later, where it was possible to verify that there were no complications from the anticoagulant treatment or signs of thrombotic recurrence. For this reason, a change from heparin to another direct-acting oral anticoagulant (DOAC) was made.
The activation of the TEP Code, in conclusion, highlights the importance of the collaboration of different specialties to decide on the best therapeutic for the patient.
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Aurora Lietor, Andreína Olavarría, Jesús Corres, Raquel Morillo, David Jiménez and Diego Durán. |
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