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{{Pulmonary embolism}}
{{CMG}}
'''Associate Editors-in-Chief:''' [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
==Overview==
'''Pulmonary embolism''' (PE) is a potentially lethal condition, with a mortality rate close to 30 percent without treatment. Thus prompt and effective therapy is utmost important. In most cases, [[anticoagulant]] therapy is the mainstay of treatment. Acutely, supportive treatments, such as [[oxygen]] or [[analgesia]], are often required.


==Treatment Algorithm==
{| class=wikitable border=1
{{familytree/start |summary=PE treatment Algorithm.}}
!Examples of prediction rules
{{familytree | | | | | | | | GMa | GMa='''Stabilize the patient'''}}
!
{{familytree | | | | | | | | |!| }}
|-
{{familytree | | | | | | | | GPa | GPa='''Is [[anticoagulation]] contraindicated ?'''}}
|Active cancer (treatment within last 6 months or palliative)
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
|style="text-align:center"|1
{{familytree | | |JOE| | | | | | | |SIS| | | JOE='''Yes'''|ME=Inconclusive study|SIS='''No'''}}
|-
{{familytree | | | |!| | | | | | | | | |!| }}
|Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity)
{{familytree | | |MOM| | | | | | | | SIS | | |MOM=[[Pulmonary embolism diagnosis|'''Diagnostic evaluation''']]|SIS=Anticoagulate with SC [[LMWH]] or IV [[Heparin|UFH]]}}
|style="text-align:center"|1
{{familytree | |,|-|^|.| | | | | | | | |!| }}
|-
{{familytree |GPa| |JOE| | | | | |A01|GPa=PE excluded|JOE='''PE confirmed'''|A01=[[Pulmonary embolism diagnosis|'''Diagnostic evaluation''']]}}
|Collateral superficial veins (non-varicose)
{{familytree | |!| | | |!| | | | | |,|-|^|.| }}
|style="text-align:center"|1
{{familytree |C01| |C02| | |C03| |C04|C01=No further Treatment|C02='''[[Inferior vena cava filter#Pulmonary embolism inferior vena cava filter|Inferior vena cava filter]]'''|C03=PE excluded|C04='''PE confirmed'''}}
|-
{{familytree | | | | | | | | | | |!| | | |!|}}
|Pitting edema (confined to symptomatic leg)
{{familytree | | | | | | | | | |SIS| |B02|SIS='''Discontinue Anticoagulants'''|B02='''Clinicaly severe enough to need [[Thrombolysis]]'''}}
|style="text-align:center"|1
{{familytree | | | | | | | | | | | | |,|-|^|-|.| }}
|-
{{familytree | | | | | | | | | | | |JOE| |SIS|JOE='''Yes'''|ME=Inconclusive study|SIS='''No'''}}
|Swelling of entire leg
{{familytree | | | | | | | | | | | | |!| | | |!| }}
|style="text-align:center"|1
{{familytree | | | | | | | | | | | |SIS| |B02|SIS='''Is [[thrombolytic]] Contraindicated?'''|B02=Continue Anticoagulants}}
|-
{{familytree | | | | | | | | | | |,|-|^|-|.| }}
|Localized pain along distribution of deep venous system
{{familytree | | | | | | | | |JOE| |SIS|JOE='''Yes'''|ME=Inconclusive study|SIS='''No'''}}
|style="text-align:center"|1
{{familytree | | | | | | | | | | |!| | | |!| }}
|-
{{familytree | | | | | | | | | |SIS| |B02|SIS='''[[Pulmonary thrombectomy|Surgical emblectomy]]''' or '''[[Pulmonary embolism catheter based interventions|catheter based interventions]]'''|B02='''Hold Anticoagulation, Give Thrombolytics then resume Anticoagulations'''}}
|Paralysis, paresis, or recent cast immobilization of lower extremities
{{familytree | | | | | | | | | | | | | | |!| | | |}}
|style="text-align:center"|1
{{familytree | | | | | | | | | | | | | |SIS|SIS=Patient show Clinically Improvement}}
|-
{{familytree | | | | | | | | | | | | |,|-|^|-|.| }}
|Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks
{{familytree | | | | | | | | | | | |JOE| |SIS|JOE='''No'''|ME=Inconclusive study|SIS='''Yes'''}}
|style="text-align:center"|1
{{familytree | | | | | | | | | | | | |!| | | |!| }}
|-
{{familytree | | | | | | | | | | | |SIS| |B02|SIS='''[[Pulmonary thrombectomy|Surgical emblectomy]]''' or '''[[Pulmonary embolism catheter based interventions|catheter based interventions]]'''|B02=Continue Anticoagulation}}
|Previously documented DVT
{{familytree/end}}
|style="text-align:center"|1


[[Category:Hematology]]
|-
[[Category:Pulmonology]]
|Alternative diagnosis at least as likely
[[Category:Cardiology]]
|style="text-align:center"| - 2
[[Category:Emergency medicine]]
|-
|}
{{WH}}
{{WS}}

Revision as of 14:41, 14 May 2012

Examples of prediction rules
Active cancer (treatment within last 6 months or palliative) 1
Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) 1
Collateral superficial veins (non-varicose) 1
Pitting edema (confined to symptomatic leg) 1
Swelling of entire leg 1
Localized pain along distribution of deep venous system 1
Paralysis, paresis, or recent cast immobilization of lower extremities 1
Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks 1
Previously documented DVT 1
Alternative diagnosis at least as likely - 2