Current approach to acute Pulmonary embolism : A three minute algorithm

Here is a 3-minute algorithm for the management of acute pulmonary embolism. Just need to ask 3 questions. Caution: User discretion is advised as it could be tainted with reasonably acceptable levels of non-scientific content. Some of the critical  questions need to be answered What is hemodynamic stability? It is purely based on clinical signs and judgment.(One need to be doubly sure to rule out hypovolemia and sepsis-related hypotension) Is RV dysfunction equivalent to hemodynamic stability? No, it is not. Clinical instability must be associated.( The dogma is,  if the patient is stable even if there is significant RV dysfunction by echo , that RV dysfunction is not attributable to the current episode of PE) Can we diagnose and proceed with lysis without CT pulmonary angiogram confirmation? Yes, you can provide your suspicion is too strong or you have the extraordinary talent to argue/defend even a fatal bleed ( with your boss or in medical audit ) in a patient who was subsequently proven not to suffer from PE . How to switch over to Lysis from Heparin alone protocol? Occasionally one may require to do it. There is an added risk of bleeding here. It can’t be avoided in some situations as Initially, it appear as low-risk PE later on becoming more Intense. Generally, high-risk unstable patients should receive lysis straightaway. Is 60/60 sign is really useful in deciding lysis? 60 /60 sign tell us if Pulmonary artery acceleration time (PAT) and the TR jet bot...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized 2020 acute pulmonary embolism guidlines 60/60 sign acc aha acc esc guideline for pulmonary embolism esc 2019 pe guidelines guidelines for pe pulmonary embolism 2020 latest pe guidline latest review article pulmoanry embolism Source Type: blogs

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ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important.Previously, Knotts et al. had published different, but also convincing, data:Knotts et al. found that such ECG findings (STE in aVR) only represented left main ACS in 14% of such ECGs: Only 23% of patients with the aVR STE pattern had any LM disease (fewer if defined as  ≥ 50% stenosis). Onl...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Abstract Pulmonary embolism (PE) is a condition characterised by an obstruction of the pulmonary arterial system by one or more emboli. Advanced clinical practitioners are often faced with ruling out a diagnosis of PE in patients with non-specific symptoms such as dyspnoea and pleuritic chest pain, which can be fairly mild and therefore a diagnosis of PE easily missed. PEs can be a challenge to diagnose, especially in elderly people, since it can be difficult to differentiate their symptoms from other less serious illnesses. Widely used scoring tools are helpful to calculate a patient's probability of having a PE....
Source: British Journal of Nursing - Category: Nursing Authors: Tags: Br J Nurs Source Type: research
Conclusions: Pulmonary artery catheter-directed thrombolysis is a technically feasible therapeutic option for children and adolescents with submassive and massive pulmonary emboli.
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Online Clinical Investigations Source Type: research
CONCLUSION: Using propensity score-matched analysis we showed that pharmacological thromboprophylaxis after EVLA seems to be equally effective with 3 days or 10 days of treatment with a similar success rate and safety profile. Undoubtedly, a large randomised control trial, ideally including a group without pharmacological thromboprophylaxis, is needed to draw more definitive conclusions on the optimal duration of pharmacological post-EVLA thromboprophylaxis. PMID: 31869428 [PubMed - in process]
Source: Swiss Medical Weekly - Category: General Medicine Authors: Tags: Swiss Med Wkly Source Type: research
Publication date: Available online 10 August 2019Source: Journal of Vascular and Interventional RadiologyAuthor(s): Andrés Camacho, Edward H. Ahn, Elisabeth Appel, Johannes Boos, Quang Nguyen, Almamoon I. Justaniah, Salomao Faintuch, Muneeb Ahmed, Olga R. BrookAbstractPurposeTo evaluate the technical and clinical success rates and safety of bilateral gelfoam uterine artery embolization (UAE) for symptomatic acquired uterine arteriovenous shunting due to prior obstetric or gynecologic event.Materials and MethodsThis was a retrospective study of consecutive patients of reproductive age who presented with abnormal uter...
Source: Journal of Vascular and Interventional Radiology - Category: Radiology Source Type: research
Conclusions: This is the first case report of PE combined with CA that did not receive reperfusion therapy. We hypothesized that there was a spontaneous resolution in pulmonary emboli.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusion: Thrombolysis is effective in majority of patients with pulmonary embolism with right ventricular dysfunction. The bleeding risk is low. PMID: 31325254 [PubMed - in process]
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
We describe the case of a 55-year-old patient with a history of pulmonary embolism who presented in shock with ST-elevation on his electrocardiogram. He was triaged to the catheterization laboratory where he suffered a cardiac arrest. A pulmonary embolism was diagnosed angiographically, the thrombus was aspirated, and he received systemic thrombolysis. The combination of clot debulking and systemic thrombolysis acted synergistically to improve his right ventricular function by resolving his pulmonary hypertension. Although it is associated with a higher bleeding risk, the combination of clot aspiration with a thrombolytic ...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
Authors: Kruger PC, Eikelboom JW, Douketis JD, Hankey GJ Abstract Pulmonary embolism (PE) is a potentially life-threatening condition, mandating urgent diagnosis and treatment. The symptoms of PE may be non-specific; diagnosis therefore relies on a clinical assessment and objective diagnostic testing. A clinical decision rule can determine the pre-test probability of PE. If PE is "unlikely", refer for a D-dimer test. If the D-dimer result is normal, PE can be excluded. If D-dimer levels are increased, refer for chest imaging. If PE is "likely", refer for chest imaging. Imaging with computed tomo...
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
Conclusions: In this pilot study, we have demonstrated the feasibility and potential utility of V/Q PET/CT for the management of patients with suspected acute PE. V/Q PET/CT may be of particular relevance in cases of equivocal findings or isolated subsegmental findings on CTPA, adding further discriminatory information to allow important decision-making regarding application or withholding of treatment courses of therapeutic anticoagulation, which may confer an increased risk of bleeding. Given the other advantages of V/Q PET/CT (reduced acquisition time, low radiation dose), and with increasing availability of 68Ga-genera...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Outcomes/Infectious Disease/Pulmonary II Source Type: research
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