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?
- History and physical examination
- 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
- Echocardiography (EKG, ECG)
- What is the treatment for pulmonary embolism?
- Anticoagulation
- Thrombolytic therapy
- What is the prognosis for pulmonary embolism?
- Can pulmonary embolism be prevented?
Ventilation-perfusion scans
Ventilation-perfusion scans (VQ scans) use labeled chemicals to identify inhaled air into the lungs and match it with blood flow in the arteries. If a mismatch occurs, meaning that there is lung tissue that has good air entry but no blood flow, it may be indicative of a pulmonary embolus. These tests are read by a radiologist as having a low, moderate, or high probability of having a pulmonary embolism. There are limitations to the test, since there may be a 5%-10% risk that a pulmonary embolism exists even with a low probability V/Q result.
Venous Doppler study
Ultrasound of the legs, also known as venous Doppler studies, may be used to look for blood clots in the legs of a patient suspected of having a pulmonary embolus. If a deep vein thrombosis exists, it can be inferred that chest pain and shortness of breath may be due to a pulmonary embolism. The treatment for deep vein thrombosis and pulmonary embolus is generally the same.
Echocardiography (EKG, ECG)
Echocardiography or ultrasound of the heart may be helpful if it shows that there is strain on the right side of the heart.
If non-invasive tests are negative and the healthcare provider still has significant concerns, then the healthcare provider and the patient need to discuss the benefits and risks of treatment versus invasive testing like angiography.
What is the treatment for pulmonary embolism?
The best treatment for a pulmonary embolus is prevention. Minimizing the risk of deep vein thrombosis is key in preventing a potentially fatal illness.
The initial decision is whether the patient requires hospitalization. Recent studies suggest that those patients with a small pulmonary embolus, who are hemodynamically stable (normal vital signs) and who can be compliant with treatment, may be treated at home with close outpatient care.
Those who are unstable need to be admitted to the hospital.
Next: Anticoagulation
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