Suspected Pulmonary Embolism Without Shock or Hypotension - Flowchart

Suspected Pulmonary Embolism Without Shock or Hypotension - Flowchart

Suspected Pulmonary Embolism Without Shock or Hypotension - Flowchart Suspected Pulmonary Embolism Without Shock or Hypotension Suspected Pulmonary Embolism Without Shock or Hypotension

Flowchart

Suspected PE without shock or hypotension

Suspected PE without shock or hypotension

Suspected PE without shock or hypotension

Suspected PE without shock or hypotension

End

End

End

No treatment^b or investigate further^d

No treatment^b or investigate further^d

No treatment^b or investigate further^d

^b ^b ^d ^d

Treatment^b

Treatment^b

Treatment^b

^b ^b

No treatment^b

No treatment^b

No treatment^b

^b ^b

D-dimer

D-dimer

D-dimer

positive

positive

positive

negative

negative

negative

Treatment^b

Treatment^b

Treatment^b

^b ^b

^a Two alternative classification schemes may be used for clinical probability assessment, i.e. a tree-level scheme (clinical probability defined as low, intermediate, or high) or a two-level scheme (PE unlikely or PE likely). When using a moderately sensitive assay. D-dimer measurements should be restricted to patients with low clinical probability or a PE-unlikely classification, while highly sensitive assays may also be used in patients which intermediate clinical probability of PE. Note that plasma D-dimer measurement is of limited use in suspected PE occurring in hospitalized patients.

^a Two alternative classification schemes may be used for clinical probability assessment, i.e. a tree-level scheme (clinical probability defined as low, intermediate, or high) or a two-level scheme (PE unlikely or PE likely). When using a moderately sensitive assay. D-dimer measurements should be restricted to patients with low clinical probability or a PE-unlikely classification, while highly sensitive assays may also be used in patients which intermediate clinical probability of PE. Note that plasma D-dimer measurement is of limited use in suspected PE occurring in hospitalized patients.

^a Two alternative classification schemes may be used for clinical probability assessment, i.e. a tree-level scheme (clinical probability defined as low, intermediate, or high) or a two-level scheme (PE unlikely or PE likely). When using a moderately sensitive assay. D-dimer measurements should be restricted to patients with low clinical probability or a PE-unlikely classification, while highly sensitive assays may also be used in patients which intermediate clinical probability of PE. Note that plasma D-dimer measurement is of limited use in suspected PE occurring in hospitalized patients.

^a

^b Treatment refers to anticoagulation treatment for PE.

^b Treatment refers to anticoagulation treatment for PE.

^b Treatment refers to anticoagulation treatment for PE.

^b

^c CT angiogram is considered to be diagnostic of PE if it shows PE at the segmental or more proximal level.

^c CT angiogram is considered to be diagnostic of PE if it shows PE at the segmental or more proximal level.

^c CT angiogram is considered to be diagnostic of PE if it shows PE at the segmental or more proximal level.

^c

^d In case of a negative CT angiogram in patients with high clinical probability, further investigation may be considered before withholding PE-specific treatment.

^d In case of a negative CT angiogram in patients with high clinical probability, further investigation may be considered before withholding PE-specific treatment.

^d In case of a negative CT angiogram in patients with high clinical probability, further investigation may be considered before withholding PE-specific treatment.

^d

CT = computed tomographic, PE = pulmonary embolism.

CT = computed tomographic, PE = pulmonary embolism.

CT = computed tomographic, PE = pulmonary embolism.

Assess clinical probability of PE
Clinical judgement or prediction rule^a

Assess clinical probability of PE
Clinical judgement or prediction rule^a

Assess clinical probability of PE
Clinical judgement or prediction rule^a

^a ^a

Low/intermediate clinical probability or PE unlikely

Low/intermediate clinical probability or PE unlikely

Low/intermediate clinical probability

High clinical probability or PE likely

High clinical probability or PE likely

High clinical probability

CT angiography

CT angiography

CT angiography

PE confirmed^c

PE confirmed^c

^c ^c PE confirmed

no PE

no PE

no PE

CT angiography

CT angiography

CT angiography

PE confirmed^c

PE confirmed^c

^c ^c PE confirmed

no PE

no PE

no PE