Clin Exp Emerg Med.  2016 Sep;3(3):117-125. 10.15441/ceem.16.146.

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

• Corrigan D
• Prucnal C
• Kabrhel C

• KMID: 2361017
• DOI: http://doi.org/10.15441/ceem.16.146

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.

Keyword

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

MeSH Terms

Angiography
Anticoagulants
Biomarkers
Catheters
Diagnosis*
Diagnostic Tests, Routine
Emergencies*
Emergency Service, Hospital*
Hospital Rapid Response Team
Humans
Outpatients
Pulmonary Embolism*
Venous Thrombosis
Anticoagulants
Biomarkers