Acute pulmonary embolism diagnostic algorithms Take home messages

Acute pulmonary embolism: diagnostic algorithms Take home messages Alexandre GHUYSEN Service des Urgences - CHU Liège Symposium Belge des Médecins de l’Urgence Bruxelles, le 16 janvier 2010

Initial Risk Stratification for Pulmonary Embolism Suspected acute PE *defined as systolic BP < 90 mm. Hg or a pressure drop of > 40 mm. Hg for > 15 min, if not cuased by new onset arythmia, hypovolemia or sepsis Shock or hypotension * Yes No High risk Non high risk Different management strategies

Emergency Diagnostic Workup for Suspected Pulmonary Embolism in a Patient with Hypotension or Shock Suspected high risk PE i. e with shock or hypotension CT immediately available No Yes Echocardiography Rv overload No Yes CT CT available Patient stabilized Positive Negative CT not available Other causes Patient unstable Konstantinides S. N Engl J Med 2008; 359: 2804 -2813 PE: treatment Other causes Eur Heart J 2008; 29: 2276 -2315

Diagnostic Algorithm for Suspected Pulmonary Embolism in a Patient without Hypotension or Shock Suspected non high risk PE i. e. without shock or hypotension Assess clinical probability of PE Implicit or prediction rule PE likely PE unlikely: low/intermediate clinical probability high clinical probability D-Dimer assay MD- CT - + MD-CT no PE - + No PE PE treatment Konstantinides S. N Engl J Med 2008; 359: 2804 -2813 no PE ( +US? ) PE treatment Eur Heart J 2008; 29: 2276 -2315