Pulmonary Embolism (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
George Schiffman, MD, FCCP
Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Pulmonary embolism facts
- What is a pulmonary embolism?
- What are the causes and risk factors for pulmonary embolism?
- What are the signs and symptoms of pulmonary embolism?
- How is pulmonary embolism diagnosed?
- PERC Rule for Pulmonary Embolus
- Basic testing (CBC, electrolytes, BUN, creatinine blood test, chest X-ray, EKG)
- Pulmonary angiogram
- d-Dimer blood test
- CT scan
- Ventilation-perfusion scans
- Venous Doppler study
- What is the treatment for pulmonary embolism?
- Thrombolytic therapy
- What is the prognosis for pulmonary embolism?
- Can pulmonary embolism be prevented?
Basic testing (CBC, electrolytes, BUN, creatinine blood test, chest X-ray, EKG)
Basic testing in the diagnosis of pulmonary embolism may include:
- CBC (complete blood count)
- BUN (blood urea nitrogen),
- Creatinine blood test (to assess kidney function; see below),
- Chest X-ray, and
- Electrocardiogram (EKG or ECG).
The chest X-ray is often normal in pulmonary embolism. The EKG may be usually normal, but may demonstrate a rapid heart rate, a sinus tachycardia (heart rate > 100 bpm). If there is significant blockage in a pulmonary artery, it acts like a dam and it is harder for the right side of the heart to push blood past the obstructing clot or clots. The EKG can demonstrate right heart muscle strain.
Since the risk of missing the diagnosis of pulmonary embolus can include death, the healthcare professional has to consider this diagnosis when caring for any patient complaining of chest pain or shortness of breath.
In the past, the gold standard for the diagnosis of pulmonary embolus was a pulmonary angiogram, where a catheter was threaded into the pulmonary arteries, usually from veins in the leg. Dye was injected and a clot or clots could be identified on imaging studies. This is considered an invasive test and is now rarely performed.
Fortunately, there are other, less invasive ways to make the diagnosis. The decision as to which test might best make the diagnosis needs to be individualized to the patient and their presentation and situation.
Next: d-Dimer blood test
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