Description
Management of pulmonary embolism (PE) involves rapid diagnosis through imaging techniques like CT pulmonary angiography and the administration of anticoagulant therapy to prevent further clot formation. In severe cases, thrombolytic therapy or surgical intervention may be necessary to remove the embolus and restore normal blood flow.
Summary Listen
- Pulmonary embolism (PE) is a complex and often missed condition, representing a significant cause of preventable death. Early diagnosis and management are crucial for saving lives. The presentation is often non-specific, making diagnosis challenging, but certain risk factors can help identify high-risk patients.
- Risk stratification scales, such as the Wells score and simplified PESI, aid in determining the likelihood of PE and guiding further investigation. ECG findings are non-specific but can indicate right ventricular strain. Bedside echocardiography is a more sensitive and specific tool for assessing right ventricular dysfunction, with the 60/60 sign being particularly useful. Doppler ultrasound of the lower extremities can confirm the presence of deep vein thrombosis (DVT), further supporting the diagnosis of PE.
- CT pulmonary angiography is the gold standard for definitive diagnosis. Once diagnosed, patients are risk-stratified using the Pulmonary Embolism Severity Index (PESI) to guide management decisions. High-risk patients with hemodynamic instability require immediate intervention, including anticoagulation and thrombolysis.
- Management strategies vary depending on the patient's risk profile. Thrombolysis with agents like tissue plasminogen activator or tenecteplase is indicated for high-risk patients, while anticoagulation is the mainstay of treatment for most cases. Vasopressors, such as norepinephrine and dobutamine, may be necessary to support blood pressure and right ventricular function. Surgical embolectomy or catheter-directed thrombolysis may be considered when thrombolysis is contraindicated or unsuccessful.
- Long-term management involves oral anticoagulants like dabigatran, rivaroxaban, or apixaban for at least six months, with indefinite continuation considered for certain high-risk groups, such as those with antiphospholipid syndrome. IVC filters may be used in cases of recurrent PE or contraindications to anticoagulation. Management of PE during pregnancy and in cancer patients requires special consideration, often favoring low molecular weight heparin.
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About the Speakers
Dr. Nilanchal Chakraborty
Consultant, Consultant Critical Care Apollo Multi Speciality Hospital, Kolkata
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