5 Steps of Pulmonary Embolism (PE) Management

Suspect PE

• Consider Risk Factors: Recent surgery, prolonged immobilization, active cancer, etc.
• Symptoms: Sudden onset of dyspnea, chest pain, and tachycardia.
• PERC Criteria: Utilized to rule out PE in low-risk patients.

Estimate Risk of PE

• Clinical Tools: Use Well’s score and Geneva score to quantify risk.
• D-dimer Testing: Helps exclude PE when negative, especially in low-risk scenarios.

Diagnose PE with Imaging

• CT Pulmonary Angiography (CTPA): Gold standard for confirming PE.
• V/Q Scan: Alternative for patients with contraindications to CT.
• Angiography: Used in select cases where non-invasive imaging is inconclusive.

Risk Stratification

• sPESI Score: Simplified Pulmonary Embolism Severity Index to guide therapy.
• RV/LV Ratio: Measured on imaging to assess right ventricular strain.
• Biomarkers: Troponin and BNP can indicate right heart stress.
• Assess Hemodynamic Stability: Determines need for thrombolysis or ECMO.

Treat PE

• Anticoagulation: Initial treatment with heparin or direct oral anticoagulants.
• Systemic Thrombolysis: Indicated in massive PE with shock.
• Catheter-Based Therapies: Used for intermediate-risk patients.
• ECMO or Surgical Embolectomy: Reserved for life-threatening PE with cardiogenic shock.

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