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Pulmonary Embolism, Emergency Medicine

Alan M. Kumar Reviewed 06/2017
 


Basics

Description

  • The majority of pulmonary embolisms (PEs) arise from thrombi in the deep veins of the lower extremities and pelvis.

  • Thrombi also originate in renal and upper extremity veins.

  • After tra...

Diagnosis

Signs and Symptoms

  • Variability in signs and symptoms make diagnosis difficult

  • Most common:

    • Dyspnea

    • Pleuritic chest pain

    • Tachypnea

  • General:

    • Fevers (rarely >102°F)

    • Diaphoresis

  • Pulmonary:

    • Cough

    • Hemopty...

Treatment

Pre-Hospital

  • Initial supplemental oxygen

  • Establish IV access

  • Cardiac monitor

Initial Stabilization/Therapy

  • Airway, breathing, and circulation

  • Provide supplemental oxygen to maintain adequate oxyge...

Follow-Up

Disposition

Admission Criteria

  • Admit all patients with PE for continued anticoagulation and observation.

  • Clinically stable patients with a high suspicion for PE, no contraindication to anticoag...

Pearls and Pitfalls

  • Clinical presentation is variable and nonspecific, making diagnosis difficult in many cases.

  • Patients with malignancy are at higher risk for Coumadin failure and recurrent PE even w...

Additional Reading

  • Kline  JA, Courtney  DM, Kabrhel  C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost.  2008;6(5):772–780.

  • Stein  P, Fowle...

Codes

ICD9

  • 415.11 Iatrogenic pulmonary embolism and infarction

  • 415.19 Other pulmonary embolism and infarction

  • 673.20 Obstetrical blood-clot embolism, unspecified as to episode of care or not applicable

ICD10

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