DVT complete diagnostic approach resident survival guide

Probability of infective endocaritis	Characteristics
Definite diagnosis by pathological criteria	❑ Microorganisms demonstrated by culture or histological examination of a vegetation, OR ❑ Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
Definite diagnosis by clinical criteria	❑ 2 major criteria; OR ❑ 1 major criterion and 3 minor criteria; OR ❑ 5 minor criteria
Possible diagnosis	❑ 1 major criterion and 1 minor criterion; OR ❑ 3 minor criteria
Rejected diagnosis	❑ Firm alternative diagnosis explaining evidence of IE, OR ❑ Resolution of IE syndrome with antibiotic therapy for 4 days, OR ❑ No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days, OR ❑ Does not meet criteria for possible IE as above

Criteria	Definite Infective Endocarditis According to Modified Duke Criteria
Pathological Criteria	Microorganisms demonstrated by culture or histological examination of a vegetation Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
Clinical Criteria	2 major criteria; or 1 major criterion and 3 minor criteria; or 5 minor criteria
Possible IE	1 major criterion and 1 minor criterion; or 3 minor criteria
Rejected	Firm alternative diagnosis explaining evidence of IE; or Resolution of IE syndrome with antibiotic therapy for 4 days; or No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days; or Does not meet criteria for possible IE as above

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Identify cardinal signs and symptoms that increase the pretest probability of pericarditis ❑ Tachycardia ❑ Hypotension ❑ Loss of consciousness ❑ Severe dyspnea

Determine if the patient is unstable

Unstable patient

Stable patient

Suspect cardiac tamponade

❑ Look for Beck's triad ❑ Pulsus paradoxus ❑ Muffled heart sounds ❑ Hypotension

Continue with complete diagnostic approach

❑ Assess airway, breathing, and circulation (ABC) ❑ Administer oxygen if necessary

❑ Treat the cardiac tamponade ❑ Resuscitate the patient ❑ Bedside echo ❑ Urgent pericardiocentesis ❑ Expert consultation