pulmonary embolism guidelines

pulmonary embolism guidelines 


 Guidelines for acute pulmonary embolism management
Diagnosis and management of acute pulmonary embolism according to the European Society of

THE GUIDELINES PROPOSE THE FOLLOWING DIAGNOSTIC / THERAPEUTIC SCHEME:

EVALUATION OF CLINICAL PROBABILITY OF ACUTE UNDERWATER EMBOLIA: INITIAL STRATIFICATION OF RISK AND ESTIMATE OF CLINICAL RISK WITH SCORE
stratification risk 2stratification risk 1

EVALUATION OF DIAGNOSTIC INSTRUMENTS and use for diagnostic criteria
D Dimero (ELISA method)
95% sensitivity if negative in low / intermediate PE probability

TC with mdc (gold standard)
negative predictive value high only if low or intermediate clinical probability (96-89%)
positive predictive value high only if intermediate or high clinical probability (92-96%)
There is no absolute contraindication during pregnancy: if possible, prefer scintigraphy

CUS (ultrasound venous compression)
Sensitivity> 90% and 95% specificity for symptomatic DVT diagnosis

high positive predictive value for PE

if positive in suspected PE administer THERAPY
Important use in renal failure, pregnancy, allergy to iodinated contrast medium, impossibility of immediate execution of chest CT

VENTRIC ECOCARDIOGRAPHY DX
More specific indicators:

Mc Connell's sign (hypokinesia free wall VD and normocinesi apex)

TAPSE (tricuspid annular plane systolic excursion)

low negative predictive value (40-50%): not indicated if stable PE, yes if unstable PE

Useful for stratification of prognosis and evaluation of unstable patient

diagnostic criteria

Note that the negativity of D dimer in clinical probability of high or probable PE is not a valid criterion for excluding PE

Note that the negativity of TC with MDC in clinical probability of high or probable PE is a controversial criterion: it is necessary to proceed with other tests (scintigraphy).

APPLICATION FLOW CHART DIAGNOSTICSflow chart diagnostics chart diagnostics 2
4. PROGNOSTIC EVALUATION WITH WEIGHTS OR sPESIpesiflow final chart

5. THERAPY IN ACUTE PHASE

Heparin ev if severe IRC

Thrombolysis if unstable patient

TAO

DAO

(SURGICAL EMBOLECTOMY)

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 Review
EMBOLIA POLMONARE, ESC 2014
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