Pulmonary Embolism
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Clinical features
Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from deep veins in the legs or, rarely, from veins in other parts of the body (deep vein thrombosis).
Investigations
Dyspnea, HTN, Hemoptysis, Difficult breathing, Chest pain, Collapse, Faintness.
Management
ECG, Arterial blood gases, D-dimer, CXR, CTPA, Echo cardiograph, Ventilation/perfusion, Pulmonary angiography.
Management
- Admit the patient and pass IV line
- Oxygen inhalation stat
- Inf - N / S 0.9 % 1L IV x stat for hypotension (N / S)
- If there is no response Add Dopamine
- Inj - morphine 15 mg / ml (1/2 cc iv stat) or Thrombolysis with Streptokinase indicated in proximal massive pulmonary emboli & hemodynamically unstable if no contra indication exists.
- Start Heparin on clinical suspicion, don't wait for investigation to confirm
- Inj - Enoxaparin (Clexane) 1.5mg / Kg / day subcutaneously. ' OR '
- Inj - Fondaparinux (Arixtra) 5-10mg S / C x OD.
- Tab- warfarin 5-15mg, 1 tab PO x OD according to INR (After 24 hours of Heparin) ' OR'
- Tab- Rivaroxaban (Xcept) 15mg, 1 tab PO x BD for 3 weeks, then 20mg OD for 6 months.
- Treat other co - morbidities if any.
- Better to refer to a Cardiologist