So, if you find that your patient has a pulmonary embolus,
you’re gonna wanna go ahead and start treatment.
The treatment for PE is medication to help thin the blood.
Generally in the emergency department, we’ll go ahead and start heparin
or a low-molecular weight heparin for all patients.
So, when you find your patient has a PE, you wanna go ahead
and get this medication started as quickly as possible.
tPA is the other medication that should be considered to be given.
tPA is a more potent blood anticoagulant and we refer to it sometimes
as a clot busting medication.
You wanna reserve this for patients who have cardiac compromise
associated with their pulmonary embolus.
So, for patients who have a larger clot burden.
For patients who have a positive troponin.
Potentially for patients who have what we call a saddle embolus
which is an embolus right at the bifurcation of the pulmonary vessels,
almost looks like a saddle.
You wanna reserve this for patients who potentially have
right heart strain on a bedside echocardiogram.
The other important point that I wanna make here is that if you think
that your patient has a pulmonary embolus, you can actually give these
medications prior to the official diagnosis being made.
So, if you have a very strong or a very high suspicion
and your patient is critically ill or unstable,
or potentially for a patient in cardiac arrest and whom you have a high suspicion,
go ahead and get these medications onboard early.
For patients in cardiac arrest for a PA arrest,
this is one of the diagnosis that can potentially cause that,
so you wanna go ahead and administer that tPA during that situation
if you have a high suspicion.
So in conclusion for pulmonary embolus.
You wanna make sure that first and foremost,
you’re thinking about this diagnosis.
Patients may present in a very subtle way.
When you’re thinking about it, go ahead and utilize your decision rules.
So, utilize the PERC rule and utilize Wells criteria
to help you figure out your next steps.
But also, don’t undermine your clinical gestalt.
Your clinical gestalt can actually take you pretty far when you’re thinking
about the pulmonary embolus diagnosis.
When you’re thinking about it, the next steps are either D-dimer testing
for a low risk patient or further additional radiologic testing
with either a CTA of the chest or a VQ scan.
Treatment for PE is heparin as well as tPA and you can get those medications
on board early if your patient’s testing or evaluation and workup is delayed in any way.