Pulmonary embolism - Revision history

DLBronstein: /* Anticoagulation */

2026-05-07T15:35:35Z

Anticoagulation

← Older revision		Revision as of 15:35, 7 May 2026
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	*Patients with mechanical prosthetic heart valve		*Patients with mechanical prosthetic heart valve
	\|-		\|-
	\| '''~~Strong~~ Contraindications'''		\| '''Contraindications'''
	\|\|		\|\|
	*Pregnancy		*Pregnancy
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	*Child-Pugh Class C Liver Disease		*Child-Pugh Class C Liver Disease
	\|\|		\|\|
			*CKD Stage V (GFR <15mL/min)
	*Pregnancy		*Pregnancy
	*Breastfeeding		*Breastfeeding
	*Child-Pugh Class C Liver Disease		*Child-Pugh Class C Liver Disease
	\|\|		\|\|
			*CKD Stage IV-V (GFR <30mL/min)
	*Pregnancy		*Pregnancy
	*Breastfeeding		*Breastfeeding

DLBronstein: /* Supportive care */

2026-05-06T21:55:33Z

Supportive care

← Older revision		Revision as of 21:55, 6 May 2026
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	**Small (250-500mL) fluid boluses may be used as part of resuscitation in patients who are hemodynamically unstable		**Small (250-500mL) fluid boluses may be used as part of resuscitation in patients who are hemodynamically unstable
	***Excessive IV fluids can worsen RV dilation and further compress LV, worsening hemodynamics		***Excessive IV fluids can worsen RV dilation and further compress LV, worsening hemodynamics
	*~~Pressors~~		*Vasopressors
	**May be used once fluids are no longer helpful		**May be used once fluids are no longer helpful
	**Norepinephrine is generally first line		**Norepinephrine is generally first line

DLBronstein: /* Additional diagnostic tools */

2026-04-25T23:41:17Z

Additional diagnostic tools

← Older revision		Revision as of 23:41, 25 April 2026
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	[[File:dsign.gif\|thumb\|D Sign<ref>http://www.thepocusatlas.com/right-ventricle</ref>]]		[[File:dsign.gif\|thumb\|D Sign<ref>http://www.thepocusatlas.com/right-ventricle</ref>]]
	~~[[File:Hamptons.jpg\|thumb\|Hampton's Hump.]]~~

	====[[CXR]]====		====[[CXR]]====
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	**Westermark's Sign		**Westermark's Sign
	***A focal area of oligemia or reduced blood flow and increased lucency distal to the pulmonary embolism		***A focal area of oligemia or reduced blood flow and increased lucency distal to the pulmonary embolism

			[[File:Hamptons.jpg\|thumb\|Hampton's Hump.]]

	====[[ECG]]====		====[[ECG]]====

DLBronstein: /* Classification */

2026-04-25T23:39:33Z

Classification

← Older revision		Revision as of 23:39, 25 April 2026
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	*Both the ESC and the AHA/ACC proposed classification of patients with acute PE into categories based on their potential risk for adverse outcomes		*Both the ESC and the AHA/ACC proposed classification of patients with acute PE into categories based on their potential risk for adverse outcomes
	**ESC 2019 Guidelines: Updated the 2011 AHA/ACC tool by splitting the intermediate or previously referred to as "submassive" patient group into those that present with low-risk features and those that present with high-risk features while maintaining stable hemodynamics.		**ESC 2019 Guidelines: Updated the 2011 AHA/ACC tool by splitting the intermediate or previously referred to as "submassive" patient group into those that present with low-risk features and those that present with high-risk features while maintaining stable hemodynamics.
			[[File:ESC2019.png\|200px\|thumb\|ESC 2019 PE Classification]]

	**AHA/ACC 2026 Guidelines: A new, 5 tier, non-validated tool using an A-E category system with multiple subcategories is presented in a way to capture higher risk patients who may not have underlying RV dysfunction or cardiac biomarker abnormalities but appear to have a higher risk for adverse outcomes as noted in their proposed D group		**AHA/ACC 2026 Guidelines: A new, 5 tier, non-validated tool using an A-E category system with multiple subcategories is presented in a way to capture higher risk patients who may not have underlying RV dysfunction or cardiac biomarker abnormalities but appear to have a higher risk for adverse outcomes as noted in their proposed D group
			[[File:AHA2026.png\|200px\|thumb\|AHA 2026 PE Classification]]

	*Categorization of PE patients allows for guidance in management decisions		*Categorization of PE patients allows for guidance in management decisions

DLBronstein: /* Workup */

2026-04-21T10:26:28Z

Workup

← Older revision		Revision as of 10:26, 21 April 2026
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	*A thorough H&P is paramount to assess probability of PE		*A thorough H&P is paramount to assess probability of PE
	*Objective scoring systems ([[Wells_criteria\|Wells]], [https://www.mdcalc.com/calc/1750/geneva-score-revised-pulmonary-embolism revised Geneva]) performs similarly to ''experienced'' clinician gestalt in assessing pretest probability<ref> American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thromboembolic Disease:, Wolf SJ, Hahn SA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease. Ann Emerg Med. 2018;71(5):e59-e109. doi:10.1016/j.annemergmed.2018.03.006 </ref> <ref> Creager MA, Barnes GD, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(12):e977-e1051. doi:10.1161/CIR.0000000000001415 </ref>		*Objective scoring systems ([[Wells_criteria\|Wells]], [https://www.mdcalc.com/calc/1750/geneva-score-revised-pulmonary-embolism revised Geneva]) performs similarly to ''experienced'' clinician gestalt in assessing pretest probability<ref> American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thromboembolic Disease:, Wolf SJ, Hahn SA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease. Ann Emerg Med. 2018;71(5):e59-e109. doi:10.1016/j.annemergmed.2018.03.006 </ref> <ref> Creager MA, Barnes GD, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(12):e977-e1051. doi:10.1161/CIR.0000000000001415 </ref>

	~~{{Wells Score}}~~

	===If pretest probability of PE is low (<15%)===		===If pretest probability of PE is low (<15%)===

DLBronstein: /* Workup */

2026-04-21T09:14:25Z

Workup

← Older revision		Revision as of 09:14, 21 April 2026
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	===Assessing Pretest Probability===		===Assessing Pretest Probability===
	*A thorough H&P is paramount to assess probability of PE		*A thorough H&P is paramount to assess probability of PE
	*Objective scoring systems (~~wells~~, revised Geneva) performs similarly to ''experienced'' clinician gestalt in assessing pretest probability<ref> American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thromboembolic Disease:, Wolf SJ, Hahn SA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease. Ann Emerg Med. 2018;71(5):e59-e109. doi:10.1016/j.annemergmed.2018.03.006 </ref> <ref> Creager MA, Barnes GD, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(12):e977-e1051. doi:10.1161/CIR.0000000000001415 </ref>		*Objective scoring systems ([[Wells_criteria\|Wells]], [https://www.mdcalc.com/calc/1750/geneva-score-revised-pulmonary-embolism revised Geneva]) performs similarly to ''experienced'' clinician gestalt in assessing pretest probability<ref> American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thromboembolic Disease:, Wolf SJ, Hahn SA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease. Ann Emerg Med. 2018;71(5):e59-e109. doi:10.1016/j.annemergmed.2018.03.006 </ref> <ref> Creager MA, Barnes GD, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(12):e977-e1051. doi:10.1161/CIR.0000000000001415 </ref>

	{{Wells Score}}		{{Wells Score}}

DLBronstein: /* Assessing Pretest Probability */

2026-04-21T09:10:44Z

Assessing Pretest Probability

← Older revision		Revision as of 09:10, 21 April 2026
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	===Assessing Pretest Probability===		===Assessing Pretest Probability===
	*A thorough H&P is paramount to assess probability of PE		*A thorough H&P is paramount to assess probability of PE
	*Objective scoring systems (wells, revised Geneva) performs similarly to ''experienced'' clinician gestalt in assessing pretest probability		*Objective scoring systems (wells, revised Geneva) performs similarly to ''experienced'' clinician gestalt in assessing pretest probability<ref> American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thromboembolic Disease:, Wolf SJ, Hahn SA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease. Ann Emerg Med. 2018;71(5):e59-e109. doi:10.1016/j.annemergmed.2018.03.006 </ref> <ref> Creager MA, Barnes GD, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(12):e977-e1051. doi:10.1161/CIR.0000000000001415 </ref>
	<ref> American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thromboembolic Disease:, Wolf SJ, Hahn SA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Acute Venous Thromboembolic Disease. Ann Emerg Med. 2018;71(5):e59-e109. doi:10.1016/j.annemergmed.2018.03.006 </ref> <ref> Creager MA, Barnes GD, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(12):e977-e1051. doi:10.1161/CIR.0000000000001415 </ref>

	{{Wells Score}}		{{Wells Score}}

DLBronstein at 09:07, 21 April 2026

2026-04-21T09:07:13Z

← Older revision		Revision as of 09:07, 21 April 2026
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	''See [[pulmonary embolism in pregnancy]] for pregnancy specific information.''<ref>D-Dimer Concentrations in Normal Pregnancy: New Diagnostic Thresholds Are Needed. Kline et all. Clinical Chemistry May 2005 vol. 51 no. 5 825-829 http://www.clinchem.org/content/51/5/825.long</ref>

	==Background==		==Background==
	Pulmonary embolism is an obstruction of one of the branches of the pulmonary arteries by material; typically a thrombus		Pulmonary embolism is an obstruction of one of the branches of the pulmonary arteries by material; typically a thrombus

DLBronstein: /* Additional Topics */

2026-04-21T09:05:18Z

Additional Topics

← Older revision		Revision as of 09:05, 21 April 2026
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	****oral ingestion or gastrointestinal absorption is limited		****oral ingestion or gastrointestinal absorption is limited
	****Severe thrombocytopenia related to chemotherapy		****Severe thrombocytopenia related to chemotherapy

	~~{{Thrombolysis PE Trials}}~~

	== Calculators ==		== Calculators ==

DLBronstein: /* Additional Topics */

2026-04-21T09:03:51Z

Additional Topics

@@ Line 300: / Line 300: @@
 </div>
-==See Also==
+==Additional Topics==
-*[[Pulmonary Embolism in Pregnancy]]
+*PERT Teams
-*[[IVC Filter]]
+**Pulmonary embolism response team (PERT) is a multidisciplinary group that provide real time expertise in management of patients at higher risk for adverse events in the setting of an acute PE
-*[[Cardiac ultrasound]]
+**Often composed of emergency medicine, pulmonology, critical care, interventional radiology, vascular surgery, cardiology, as well as nursing and pharmacy
-{{Thrombolysis Submassive PE Trials}}
+**60% of all PERT activations originate in the ED and have been shown to improve overall care and reduce disposition times, as well as facilitate advanced therapies <ref> Schultz J et al. EXPRESS: A Multidisciplinary Pulmonary Embolism Response Team (PERT) - Experience from a national multicenter consortium. Pulm Circ. Published online January 11, 2019. doi:10.1177/2045894018824563 </ref>
 == Calculators ==