DVT complete diagnostic approach resident survival guide: Difference between revisions
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{{familytree | | | | | | | |!| | | |!| | | | }} | {{familytree | | | | | | | |!| | | |!| | | | }} | ||
{{familytree | | | | | | | I01 | | I02 | | I01=Hold anticoagulation and give thrombolytics| I02= Surgical pulmonary embolectomy <br> OR <br> Percutaneous catheter embolectomy}} | {{familytree | | | | | | | I01 | | I02 | | I01=Hold anticoagulation and give thrombolytics| I02= Surgical pulmonary embolectomy <br> OR <br> Percutaneous catheter embolectomy}} | ||
{{familytree | | | | | | | |!| | | }} | |||
{{familytree | | | | | | | J01 | | J01= '''Does the patient fail to improve''' <br> OR <br> '''Develop cardiogenic shock?'''<br> OR <br> '''Develop hypotension?'''}} | |||
{{familytree | | | | | |,|-|^|-|.| }} | |||
{{familytree | | | | | K01 | | K02 | K01= YES | K02= NO }} | |||
{{familytree | | | | | |!| | | |!| | | }} | |||
{{familytree | | | | | L01 | | L02 | L01= Surgical pulmonary embolectomy <br> OR <br> Percutaneous catheter embolectomy| L02= Continue with the same treatment}} | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 18:28, 9 May 2014
| Assess the severity of pulmonary embolism | |||||||||||||||||||||||||||||||||||||||||||||||||
| High-risk PE (also know as massive PE) Cardiogenic shock OR Persistent hypotension (≤90mmHg) OR Drop of the blood pressure by ≥ 40mmHg for > 15 min | Intermediate-risk PE (also know as submassive PE) Right ventricular dysfunction AND/OR Myocardial injury (Troponin +) | Low-risk PE (also know as non-massive PE) 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? | 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 Hospital admission | IVC filter AND Hospital admission | Anticoagulation therapy AND Early discharge/home treatment | IVC filter AND Early discharge/home treatment | ||||||||||||||||||||||||||||||||||||||||||||
| Does the patient fail to improve OR Develop cardiogenic shock? OR Develop hypotension? | Does the patient fail to improve OR Develop cardiogenic shock? OR Develop hypotension? | ||||||||||||||||||||||||||||||||||||||||||||||||
| YES | NO | YES | NO | ||||||||||||||||||||||||||||||||||||||||||||||
| Surgical pulmonary embolectomy OR Percutaneous catheter embolectomy | Continue with the same treatment | Is there any contraindication for fibrinolytic therapy? | Continue with the same treatment | ||||||||||||||||||||||||||||||||||||||||||||||
| NO | YES | ||||||||||||||||||||||||||||||||||||||||||||||||
| Hold anticoagulation and give thrombolytics | Surgical pulmonary embolectomy OR Percutaneous catheter embolectomy | ||||||||||||||||||||||||||||||||||||||||||||||||
| Does the patient fail to improve OR Develop cardiogenic shock? OR Develop hypotension? | |||||||||||||||||||||||||||||||||||||||||||||||||
| YES | NO | ||||||||||||||||||||||||||||||||||||||||||||||||
| Surgical pulmonary embolectomy OR Percutaneous catheter embolectomy | Continue with the same treatment | ||||||||||||||||||||||||||||||||||||||||||||||||