Pulmonary emboli and venous thromboses

Published on 14/03/2015 by admin

Filed under Emergency Medicine

Last modified 14/03/2015

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Chapter 10 Pulmonary emboli and venous thromboses

Diagnosis and differential diagnosis

The diagnosis is often difficult and approaches to diagnosis remain in a state of flux. Classical signs and symptoms occur only occasionally, and most are non-specific. Clinical judgment enhances the ability of investigations to predict PE, and is now used in most PE investigation algorithms, in association with calculation of pre-test probability (PTP) of PE based on symptoms, signs and risk factors.4

PE rule-out criteria (PERC)

A gestalt suspicion of low probability of PE together with a refinement of Wells criteria4 has been developed and trialled to exclude PE in outpatient populations.5,6 These PE rule-out criteria (PERC) are: age < 50 years, pulse < 100/min, SaO2 ≥ 95%, no haemoptysis, no oestrogen use, no surgery/trauma requiring hospitalisation within 4 weeks, no prior venous thromboembolism (VTE) and no unilateral leg swelling.

In a large multicentre study, the combination of low suspicion and negative PERC reduced the probability of VTE to below 2% in those with low suspicion of PE.6

CT pulmonary angiography

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