Livoa LogoLivoa
Pathway for the Diagnosis and Management of Pulmonary Embolism
Diagnosis
Acute Management
Chronic Management
Suspected PE (Dyspnea, Chest pain, Pre-syncope or Syncope, Hemoptysis)
Search for other diagnosis
Significant RV dysfunction on TTE
CTPA immediately available and feasible
Evidence of PE on CTPA
High risk PE
PERT activation
Search for other diagnosis
Assess clinical probability of PE
Low or Intermediate Clinical Probability
High Clinical Probability
D Dimer test
Evidence of PE on CTPA
Search for other diagnosis
Anticoagulation
Coumadin
LMWH
DOAC
Heparin
PERT activation
Assess severity of PE: 1. Simplified PESI Score >=1 or 2. RV dysfunction on TTE or CTPA 3. Troponin (consider BNP or NT Pro BNP)
sPESI 80, 90, 100, 110, C, C Age>80 Sat<90% SBP<100mmHg, HR>110 Cancer CHF, COPD
Low risk PE
Intermediate Low risk PE
Intermediate High risk PE
Evaluate if all true: 1. No other reasons for hospitalization 2. Family or social support 3. Easy access to medical care
Cardiology or Medical Floor
Critical Care Unit
Discharge Home on DOAC except patients with triple + APLA
Continue anti coagulation for 3-6 months and F/U Coagulation Clinic
At 3-6 month: any positive testing? 1. Doppler US of legs 2. RV dysfunction on TTE 3. Positive D Dimer
Continue A/C and determine probability of PH/CTEPH
Stop A/C and consider prophylaxis in high risk population

Pathway for diagnosis and management of pulmonary embolism

by khaled

0
0 uses