Suspected Pulmonary Embolism with Shock or Hypotension - Flowchart

Suspected Pulmonary Embolism with Shock or Hypotension - Flowchart

Suspected Pulmonary Embolism with Shock or Hypotension - Flowchart Suspected Pulmonary Embolism with Shock or Hypotension Suspected Pulmonary Embolism with Shock or Hypotension

Flowchart

Suspected PE with shock or hypotension

Suspected PE with shock or hypotension

Suspected PE with shock or hypotension

Suspected PE with shock or hypotension

End

End

End

Echocardiography

Echocardiography

Echocardiography

Search for other causes of haemodynamic stability

Search for other causes of haemodynamic stability

Search for other causes of haemodynamic stability

Search for other causes of haemodynamic stability

PE-specific treatment: primary reperfusion^c

PE-specific treatment: primary reperfusion^c

PE-specific treatment: primary reperfusion^c

PE-specific treatment: primary reperfusion^c ^c ^c

CT angiography

CT angiography

CT angiography

Positive

Positive

Positive

Negative

Negative

Negative

Search for other causes of haemodynamic instability

Search for other causes of haemodynamic instability

Search for other causes of haemodynamic instability

Search for other causes of haemodynamic instability

^a Includes the cases in which the patient's condition is so critical that is only allows bedside diagnostic test.

^a Includes the cases in which the patient's condition is so critical that is only allows bedside diagnostic test.

^a Includes the cases in which the patient's condition is so critical that is only allows bedside diagnostic test.

^a

^b Apart from the diagnosis of RV dysfunction, bedside transthoracic echocardiography may in some cases, directly confirm PE by visualizing mobile thrombus in the right heart chamber. Ancillary bedside imaging tests include transoesophageal echocardiography, which may detect emboli in the pulmonary artery and its main branches, and biateral compression venous ultrasonography, which may confirm deep vein thrombosis and thus be of help in emergency management decisions.

^b Apart from the diagnosis of RV dysfunction, bedside transthoracic echocardiography may in some cases, directly confirm PE by visualizing mobile thrombus in the right heart chamber. Ancillary bedside imaging tests include transoesophageal echocardiography, which may detect emboli in the pulmonary artery and its main branches, and biateral compression venous ultrasonography, which may confirm deep vein thrombosis and thus be of help in emergency management decisions.

^b Apart from the diagnosis of RV dysfunction, bedside transthoracic echocardiography may in some cases, directly confirm PE by visualizing mobile thrombus in the right heart chamber. Ancillary bedside imaging tests include transoesophageal echocardiography, which may detect emboli in the pulmonary artery and its main branches, and biateral compression venous ultrasonography, which may confirm deep vein thrombosis and thus be of help in emergency management decisions.

^b

^c Thrombolysis, alternatively, surgical embolectomy or catheter-directed treatment (Section 5)

^c Thrombolysis, alternatively, surgical embolectomy or catheter-directed treatment (Section 5)

^c Thrombolysis, alternatively, surgical embolectomy or catheter-directed treatment (Section 5)

^c

CT = computed tomographic; PE = pulmonary embolism; RV = right ventricle.

CT = computed tomographic; PE = pulmonary embolism; RV = right ventricle.

CT = computed tomographic; PE = pulmonary embolism; RV = right ventricle.

CT angiography immediately available

CT angiography immediately available

CT angiography immediately available

Yes

Yes

Yes

No^a

No^a

^a ^a No

RV overload^b

RV overload^b

RV overload^b

^b ^b

Yes

Yes

Yes

No^a

No^a

^a ^a No

CT angiography available and patient stabilized

CT angiography available and patient stabilized

CT angiography available

No other test available^b or patient unstable

No other test available^b or patient unstable

^b ^b No other test available