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Review
. 2016 Sep 30;3(3):117-125.
doi: 10.15441/ceem.16.146. eCollection 2016 Sep.

Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients

Daniel Corrigan  1 , Christiana Prucnal  1 , Christopher Kabrhel  1
Affiliations
Review

Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients

Daniel Corrigan et al. Clin Exp Emerg Med. .

Abstract

The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis. In recent years, several advances in treatment have also emerged. Novel, direct-acting oral anticoagulants make the outpatient treatment of low risk PE easier than before. However, the spectrum of PE severity varies widely, so emergency physicians must be able to risk-stratify patients to ensure the appropriate disposition. Finally, PE response teams have been developed to facilitate rapid access to advanced therapies (e.g., catheter directed thrombolysis) for patients with high-risk PE. This review will discuss the clinical challenges of PE diagnosis, risk stratification and treatment that emergency physicians face every day.

Keywords: Hospital rapid response team; Pulmonary embolism; Risk stratification; Thrombolysis; Venous thrombosis.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Pulmonary embolism response team (PERT) approach. ED, emergency department; ICU, intensive care unit; PE, pulmonary embolism.
See this image and copyright information in PMC

References

    1. Office of the Surgeon General . The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism [Internet] Rockville, MD: US Department of Health and Human Services; 2008. [cited 2016 Jun 6]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK44178/ - PubMed
    1. Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113:577–82. - PubMed
    1. Fanikos J, Piazza G, Zayaruzny M, Goldhaber SZ. Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost. 2009;102:688–93. - PubMed
    1. Singh A, editor. Scientific American medicine. Hamilton, ON: Decker Intellectual Properties; 2015.
    1. Heit JA, Sobell JL, Li H, Sommer SS. The incidence of venous thromboembolism among Factor V Leiden carriers: a community-based cohort study. J Thromb Haemost. 2005;3:305–11. - PubMed