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Abstract: The patient, a 63-year-old male with left lower extremity venous thrombosis and a history of steroidal diabetes mellitus, presented with pulmonary embolism for more than 50 days and was admitted to the hospital for review. On admission, the patient’s vital signs were normal, the breath sounds were coarse in both lungs, no dry and wet rales were heard, and good results were given for three tests of the pulmonary artery as well as the myocardium, which proved that the patient was improving. The patient was discharged from the hospital and continued to take medication and was re-examined at the hospital 2 months later.
Basic information】Male, 63 years old
Disease Type】Pulmonary embolism
Hospital】The First Hospital of China Medical University
Date of consultation】August 2021
Treatment plan】Oral medication (Rivaroxaban tablets, Reglanet tablets, Cefixime dispersible tablets)
Treatment period】Inpatient treatment for 1 day, review after 2 months
Treatment effect] The condition was basically stable, and the pulmonary embolism in both lungs was significantly absorbed.
I. Initial interview
When first seen, the patient presented with a normal face, normal gait, nutrition and body shape. He reported previous venous thrombosis of the left lower extremity and a history of steroidal diabetes mellitus. The main cause of pulmonary embolism was more than 50 days, and the patient was seen in our hospital for review. Physical examination was given, which showed T: 36°C, P: 70 beats/min, R: 18 beats/min, BP: 100/70 mmHg, coarse breath sounds in both lungs on auscultation, no obvious dry and wet rales were heard, heart rate was 70 beats/min and rhythmical, and was not accompanied by edema in both lower extremities. CTA examination of the pulmonary arteries showed that the lumen of the main pulmonary artery was not significantly thickened and the lumen was well filled with contrast; filling defects were seen in the left and right pulmonary arteries and both pulmonary artery branches. The initial diagnosis of pulmonary embolism was made and the patient was admitted to the hospital for treatment.
II. Treatment history
The patient was admitted to the hospital and the three myocardial tests showed that troponin I was <0.100ng/mL, myoglobin 14.22ng/mL, and creatine kinase isoenzyme 1.34ng/mL. After comprehensive examination results, the patient was considered to have satisfactory conservative treatment effect, and was given anticoagulant rivaroxaban tablets for treatment after communication with the patient, which can inhibit clotting factors, avoid thrombosis and relieve pulmonary embolism. The patient was given cefixime dispersible tablets to relieve the lung infection. At the same time, in response to the patient's history of diabetes, the patient was given Reglanet tablets for oral treatment to lower the blood glucose level. As the patient's condition was relatively stable, he was discharged from the hospital and still needed to take the above drugs regularly after discharge.
III. Treatment effect
After regular drug treatment, the patient’s pulmonary infection symptoms were reduced on the day of admission, and the pulmonary embolism as well as steroidal diabetes mellitus were more stable. On the second day of admission, i.e. the day of discharge, the patient showed a slight cough with a small amount of white mucous sputum, and the examination showed coarse breath sounds in both lungs, no dry and wet rales were heard, and the heart rate was 70 beats/minute, rhythmical, without other uncomfortable symptoms. The patient’s condition was stable and the patient was discharged with satisfactory treatment results. Two months after discharge, the patient was re-examined by pulmonary artery CTA, which showed that the pulmonary embolism in both lungs was basically absorbed, and no abnormal changes such as coughing, coughing mucous sputum and coarse breath sounds in the lungs were observed.
IV. Precautions
I am very happy that the patient’s condition is stable after regular medication and general conditioning treatment, but the following precautions still exist.
1. patients need to actively take medication after discharge from the hospital and avoid stopping or reducing the dosage on their own so as not to affect disease recovery.
2, in daily life, patients need to pay attention to rest, ensure sufficient sleep, avoid staying up late and overworking. If the patient is bedridden for a long period of time, the family should regularly help the patient to turn over to avoid pressure sores.
3. Establish good hygiene habits, scrub the skin regularly, trim the nails, and wear a mask when going out.
4.Choose light and nutritious food, such as milk, eggs, lean meat, etc., which can provide nutrients for patients and promote recovery.
V. Personal insight
Pulmonary embolism disease is relatively serious, easily affecting normal breathing, with symptoms such as dyspnea, hemoptysis and chest pain, usually induced by venous thrombosis of lower limbs. In the process of pulmonary embolism treatment, due to the long course of the disease, it is necessary to take drugs regularly like the patient in this case, and the disease is generally treated better. At the same time, the patient should be followed up on time, and if the symptoms of discomfort appear, he should also go to the hospital in time, which can effectively inhibit the development of the disease and prevent the occurrence of embolism in other parts.