Pulmonary embolism March 2018 | by EMauthor Pulmonary embolism is a life-threatening condition that can be difficult to diagnose. Most patients with PE are breathless and/or tachypnoeic but the absence of these features is not reliable enough to exclude the diagnosis. The PIOPED trial correlated common signs and symptoms with proven pulmonary emboli, summarised below.
Investigation and treatment of suspected PE in the ED (as per NICE) •Urgent CXR to rule out other causes •ECG to look for right heart strain •Assess the two-level PE Wells score to estimate the clinical probability of PE. oClinical features of deep vein thrombosis (minimum of leg swelling and pain with palpation of the deep veins) — 3 points. oHeart rate greater than 100 beats per minute — 1.5 points. oImmobilization for more than 3 days or surgery in the previous 4 weeks — 1.5 points. oPrevious deep vein thrombosis or pulmonary embolism — 1.5 points. oHaemoptysis — 1 point. oCancer (receiving treatment, treated in the last 6 months, or palliative) — 1 point. oAn alternative diagnosis is less likely than pulmonary embolism — 3 points. •For people with a Wells score of more than 4 points (PE likely): oArrange hospital admission for CTPA oGive interim Rivaroxaban 15 mg twice daily if no contraindications •For people with a Wells score of 4 points or less (PE unlikely), arrange a D-dimer test: oIf the test is positive, arrange hospital admission for CTPA and give Rivaroxaban 15 mg twice daily if no contraindications oIf the test is negative consider an alternative diagnosis Medical Ambulatory Emergency Care Unit The Medical Ambulatory Emergency Care Unit based on AMU East can accept stable PE patients. A Wells score is mandatory and a matter of professional courtesy.
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