Guidelines for the Diagnosis and Management of DVT and PE

This is a review of the updated guidelines on Diagnosis and Management of DVT and PE, which were released in March 2020 by the National Institute for Health and Care Excellence(NICE). They now incorporate the use of age adjusted D-dimers and the PERC(Pulmonary Embolism Rule-Out Criteria). They cover the management of different causes of thromboembolism…

Read More

Age-Adjusted D-dimer for ruling out pulmonary embolism

We use D-dimer in patients with a low probability of a pulmonary embolism, to rule out the condition and thus avoid imaging. The level of D-dimer rises with many conditions and also with age, thereby reducing it’s specificity for this condition. In a retrospective cohort study of D-dimer cut-offs, Ackerly et al(1)  compared three proposals for…

Read More

Which Patients with Pulmonary Embolism should get Thrombolysis?

The diagnosis of pulmonary embolism(PE) is an almost common occurrence in the emergency department. The question of which patients to thrombolyse can be a difficult one to answer. Certainly there is consensus over patients with massive PEs needing thrombolysis. The same cannot be said for those patients with a submissive PE, because our greatest fear is…

Read More

How Dangerous is Pulmonary Embolism?

How Dangerous is Pulmonary Embolism? The diagnosis and management of pulmonary embolism(PE), like most things in emergency medicine; it’s about risk stratification. In chest pain, the low risk patient is approached very differently to the high risk, ST elevation chest pain patient. It is exactly the same in PE. There is that group of patients…

Read More

Pulmonary Embolism in Patients With Syncope

HOT OFF THE PRESS Prandoni P et al. Prevalence of Pulmonary Embolism among Patients Hospitalised for Syncope. NEJM 375:16 Oct 20 2016. This is a big study in the NEJM, that a lot of people will pay attention to. The finding in a nutshell, was that Pulmonary Embolism(PE) occurs in 1 in 6 patients hospitalised…

Read More