Pulmonary embolism (PE)

Diagnostic and therapeutic approach

  1. Diagnosis
  2. Scores
  3. Treatment
  4. Pharmaceuticals
  5. ESC recommandations

Diagnosis

Probability of pulmonary embolism

If high probability do CT scan.

Low or intermediate probability dose D-dimers. If D-dimers normal no treatment if D-dimers augmented CT scan or echocardiography.

If diagnosis of pulmonary embolism confirmed or probable estimate the risk to start treatment.

  • BP > 90 mm Hg, biomarkers and echo negatives, low risk.
  • BP > 90 mm Hg, biomarkers high (BNP, troponine) and positive echocardiography, intermediate risk.
  • BP < 90 mm Hg, shock, resuscitation high risk.

Predisposing factors

High risk

  • Bone leg fracture, hip or knee surgery.
  • History of venous thrombosis or MI in the last 3 months.
  • Major general trauma or vertebral trauma.
  • Atrial flutter or heart failure.

Intermediate risk

  • Post-partum, Thrombophilia, Contraception, Infection, Superficial venous thrombosis.
  • CVA, Cancer, Colic inflammatory disease.

Risque faible

  • Diabetes, Hypertension, Status varicose.
  • Advanced age, Pregnancy, Obesity.
  • Laparoscopy, Bed rest > 3 days.