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Pulmonary Embolism

Reviewed 06/2022
 


BASICS

Pulmonary embolism (PE) is an acute cardiovascular disorder that requires emergent medical attention due to its high early mortality rates. PE causes pulmonary vascular bed obstruction, which r...

DIAGNOSIS

  • Establish a pretest probability based on clinical criteria.

    • Wells score

      • Clinical signs and symptoms of DVT +3

      • Alternative diagnosis is less likely than PE +3.

      • Heart rate >100 +1.5

      • Immobilizati...

TREATMENT

Treatment is based on risk stratification. 
  • Low risk PE → use anticoagulation or inferior vena cava (IVC) filter.

  • Submassive PE → anticoagulation + possible INR-guided thrombolysis

  • Massive PE →...

ONGOING CARE

Duration of anticoagulation 
  • Provoked PE (trigger no longer present): 3 months

  • Unprovoked PE: >3 months; consider long-term or prolonged secondary prophylaxis if bleeding risk is low . H...

REFERENCE

1
Lee LH, Gallus A, Jindal R, et al. Incidence of venous thromboembolism in Asian populations:a systemic review. Thromb Haemost. 2017;117(12):2243–2260.

CODES

ICD10

  • I26.99 Other pulmonary embolism without acute cor pulmonale

  • I27.82 Chronic pulmonary embolism

SNOMED

  • 59282003 Pulmonary embolism (disorder)

  • 133971000119108 chronic pulmonary embolism (disorder)

  • ...

CLINICAL PEARLS

Use Wells criteria; obtain D-dimer for low and intermediate risk; spiral CT angiography for high risk​​​​​​ 

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