Pulmonary embolism

Headline
Etiology
Epidemiology Risk factors - see Wells score. Malignancy, hypercoagulability (e.g. nephrotic syndrome)
Clinical presentation Ddx:
Pathogenesis Lung role in filtering out clots something something
Diagnostic investigations CTPA, V/Q scan
Management Complications: Right heart failure, arrest

- DOAC for ambulatory patients; LMWH for inpatients (or UFH in special circumstances)
- Thrombolysis if unstable
- IVC filter... when?
- VA ECMO
Prevention

Risk stratification tools

Do they have a PE?

  • YEARS criteria
  • PERC
  • Wells

Is this patient suitable for ambulatory treatment?/What is the likely outcome?

  • Hestia
  • PESI - for low-risk patients who may be safe for OP management
  • Bova score - normotensive patients at risk of early deterioration
    • needs troponin

How bad is this PE?

  • 2026 American guidelines:

Decision to thrombolyse

https://thorax.bmj.com/content/58/6/470

Patient counselling materials

V/Q vs CTPA in pregnancy

Direct pdf: https://yourhealth.leicestershospitals.nhs.uk/library/csi/imaging/2390-having-a-vq-or-ctpa-scan-in-pregnancy-to-check-for-a-blood-clot-in-your-lungs/file

#respiratory #incomplete

Massive pulmonary embolism

https://litfl.com/goodbye-massive-and-submassive/ - https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415
https://rebelem.com/mdcalc-wars-spesi-vs-bova-score-pe-risk-stratification-made-practical/