SHM's Clinical Quick Talks-Algorithm for PE Diagnosis

Pdf Summary
The algorithm for the diagnosis of pulmonary embolism (PE) consists of several key points. PE is a condition where there is a blockage in the pulmonary artery or one of its branches, causing infarction and cardiovascular compromise. There are various classifications for PE based on the presentation, severity, location, and presence of symptoms. The incidence of PE increases with age, and it is estimated that there are 60,000 to 100,000 deaths annually in the United States due to PE.<br /><br />The risk factors for PE can be inherited or acquired, and the pathogenesis is based on Virchow's Triad. The most common source of emboli is the proximal veins of the lower extremities. Symptoms of PE include dyspnea, pleuritic chest pain, cough, calf pain or swelling, and hemoptysis. Signs include tachypnea, calf swelling, tenderness or redness, tachycardia, rales, diminished breath sounds, and jugular venous distension. Laboratory tests and EKG findings are generally nonspecific but can aid in prognostication.<br /><br />The definitive diagnosis of PE is confirmed through imaging such as a CT pulmonary angiogram (CTPA). Risk assessment tools, such as Wells' Score, Geneva Score, or PERC Score, can help determine the pre-test probability of PE and guide further testing. Treatment involves initiating anticoagulation once the diagnosis is confirmed. The method of anticoagulation depends on the severity of PE, with outpatient treatment options for low-risk cases and inpatient treatment options for intermediate and high-risk cases. The duration of treatment should be individualized based on various factors.<br /><br />Clinical pearls include utilizing risk assessment tools to determine the pre-test probability of PE, using D-Dimer in conjunction with risk assessment tools to improve sensitivity, and considering a transthoracic echocardiogram (TTE) to evaluate for right ventricular strain if there is evidence of right heart dysfunction.<br /><br />Overall, this algorithm provides a systematic approach to the diagnosis and treatment of PE, taking into account different risk factors, symptoms, and imaging modalities. It emphasizes the importance of individualized treatment and incorporates clinical pearls to guide decision-making.
Asset Subtitle
Adriem Q. Ortiz, Kathrun Haroldson
Keywords
pulmonary embolism
diagnosis
PE
risk factors
symptoms
imaging
anticoagulation
treatment
CTPA
individualized treatment