DVT complete diagnostic approach resident survival guide: Difference between revisions

Revision as of 17:04, 9 May 2014

Assess the severity of pulmonary embolism

High
Cardiogenic shock
OR
Persistent hypotension (≤90mmHg)
OR
Drop of the blood pressure by ≥ 40mmHg for > 15 min

Intermediate
Right ventricular dysfunction
AND/OR
Myocardial injury (Troponin +)

Low
No shock
AND
No hypotension
AND
No right ventricular dysfunction
AND
No myocardial injury (Troponin -)

Is there any contraindication for fibrinolytic therapy?

Is there any contraindication for anticoagulation therapy?

NO

YES

NO

YES

NO

YES

Fibrinolytic therapy

Surgical pulmonary embolectomy
OR
Percutaneous catheter embolectomy

Anticoagulation therapy
AND
Early discharge

IVC filter
AND
Early discharge/home treatment

Anticoagulation therapy
AND
Ward admission

IVC filter
AND
Ward admission

Does the patient fail to improve
OR
Develop cardiogenic shock or hypotension?

YES

NO

Is there any contraindication for fibrinolytic therapy?

Continue with the same treatment

NO

YES

Fibrinolytic therapy

Surgical pulmonary embolectomy
OR
Percutaneous catheter embolectomy

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 {{familytree | | | | | | | | | | | A01 | | | | | | | | | | | | A01= '''Assess the severity of pulmonary embolism'''}}
 {{familytree | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | | | | }}
-{{familytree | | | B01 | | | | | | B02 | | | | | | B03 | | | | B01= '''High''' <br> Shock <br> AND/OR <br> Hypotension| B02= '''Intermediate''' <br> Right ventricular dysfunction <br> AND/OR <br> Myocardial injury (Troponin +)| B03= '''Low''' <br> No shock <br> AND <br> No hypotension <br> AND <br> No right ventricular dysfunction <br> AND <br> No myocardial injury (Troponin -)}}
+{{familytree | | | B01 | | | | | | B02 | | | | | | B03 | | | | B01= '''High''' <br> Cardiogenic shock <br> OR<br> Persistent hypotension (≤90mmHg)<br> OR<br> Drop of the blood pressure by ≥ 40mmHg for > 15 min| B02= '''Intermediate''' <br> Right ventricular dysfunction <br> AND/OR <br> Myocardial injury (Troponin +)| B03= '''Low''' <br> No shock <br> AND <br> No hypotension <br> AND <br> No right ventricular dysfunction <br> AND <br> No myocardial injury (Troponin -)}}
 {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | }}
 {{familytree | | | C01 | | | | | | C02 | | | | | | C03 | | | | C01= '''Is there any contraindication for fibrinolytic therapy?'''| C02= '''Is there any contraindication for anticoagulation therapy?'''| C03= '''Is there any contraindication for anticoagulation therapy?'''}}