This document discusses pulmonary embolism (PE), including:
1) The most common complaint is shortness of breath, but dyspnea occurs in 73% of cases. The best initial test is CT angiogram. Treatment is anticoagulation.
2) Signs of PE include leg findings like swelling in 47% of cases and tachycardia in 24% of cases.
3) The Wells Criteria and PERC rules help determine pre-test probability of PE. A negative D-dimer test is useful to rule out PE in low probability patients, though the test has many false positives.
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Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), constitute a major global burden of disease.
A pulmonary embolism (PE) is a blood clot that develops in a blood vessel in the body (often in the leg). It then travels to a lung artery where it suddenly blocks blood flow.
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An short overview of the diagnostic approach and treatment options for Pulmonary Embolism which is a Medical Emergency. In the USA alone about 600,000 people are diagnosed with Pulmonary Embolism every year. However, this is just the tip of the iceberg as many more people have sudden head due to this notorious condition. This Power Point presentation will give you some idea based on my experience in the Emergency Departments in 3 continents of the world.
Pulmonary embolism - Diagnosis and managementDr Vivek Baliga
Pulmonary embolism is a common problem seen in medical practice. This presentation by Dr Vivek Baliga discusses the basic aspects and evidence behind current management.
Diagnosis of Pulmonary Embolism is often difficult. This presentation highlights step-wise and practical approach to the diagnosis of PE in short and precise fashion.
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http://sandymillin.wordpress.com/iateflwebinar2024
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For more information, visit-www.vavaclasses.com
2. What’s Inaccurate About
PEs?
• Most common complaint = SOB
• Most common EKG finding = S1Q3T3
• Most common ABG = R. Alkalosis
• Risk factors = Virchow’s Triad
• Best initial test = CTA
• Definitive test = Angiogram
• CXR Findings = Wedge shaped pleural
density or a central black area (Plus non-specific
findings)
– Hamptom’s Hump or Westermark’s Sign
• Treatment = Anticoagulation
4. ●Dyspnea 73%
●Pleuritic pain 66%
●Cough 37%
●Orthopnea 28%
●Calf or thigh pain and/or swelling 44%
●Wheezing 21%
●Hemoptysis 13%
Stein PD et al Chest. 1991;100(3):598.
Symptoms of PE
5. ●Leg findings 47%
Calf or thigh swelling, erythema, edema, tenderness, palpable cords
●Tachycardia 24%
●Rales 18%
●Decreased breath sounds 17%
●JVD 14%
●Fever mimicking pneumonia 3%
Stein PD et al Chest. 1991;100(3):598.
Signs of PE
6. Well’s Criteria
• Sign of or Hx of DVT 3 Points
• PE your number one thought? 3 Points
• Tachycardia 1.5 Points
• Immobilization 1 Points
• Hemoptysis 1 Points
• Cancer 1 Points
7. • Score >6.0 — High
– Probability 59%
• Score 2.0 to 6.0 — Moderate
– Probability 29%
• Score <2.0 — Low
– Probability 15%
Stein PD et al Radiology. 242 (1): 15–21. doi:10.1148/radiol.2421060971. PMID 17185658.
Well’s Criteria
12. Cochrane Data
Regarding D. Dimers
• Limited evidence
• Few false-negatives
• Very high levels of false-positive
• This makes the test useful as a rule-out test
but means that a positive result requires
diagnostic imaging
13. Authors’ Conclusions:
• A negative D-dimer test is valuable to rule out
PE with a low PTP.
• Evidence from one study suggests that this
test may have less utility in older populations,
but no empirical evidence was available to
support an increase in the diagnostic
threshold of interpretation of D-dimer results
for those over the age of 65 years.
14. Chest or Pulmonary
Symptoms?
• Document on your charts:
100% of the time!!!
• 1) Arterial risk factors
• 2) Venous risk factors - Virchow’s
Triad
• 3) Symmetrical legs - “No Homan’s
Sign”
