DVT complete diagnostic approach resident survival guide: Difference between revisions
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{{familytree | | | | | | | | | | | A01 | | | | | | | | | | | | A01= '''Assess the severity of pulmonary embolism'''}} | {{familytree | | | | | | | | | | | A01 | | | | | | | | | | | | A01= '''Assess the severity of pulmonary embolism'''}} | ||
{{familytree | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | | | | }} | {{familytree | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | | | | }} | ||
{{familytree | | | B01 | | | | | | B02 | | | | | | B03 | | | | B01= '''High-risk PE''' <br> ''(also know as massive PE)'' <br> Cardiogenic shock <br> OR<br> Persistent hypotension (≤90mmHg)<br> OR<br> Drop of the blood pressure by ≥ 40mmHg for > 15 min| B02= '''Intermediate-risk PE''' <br> Right ventricular dysfunction <br> AND/OR <br> Myocardial injury (Troponin +)| B03= '''Low-risk PE''' <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-risk PE''' <br> ''(also know as massive PE)'' <br> Cardiogenic shock <br> OR<br> Persistent hypotension (≤90mmHg)<br> OR<br> Drop of the blood pressure by ≥ 40mmHg for > 15 min| B02= '''Intermediate-risk PE''' <br> ''(also know as submassive PE)'' <br> Right ventricular dysfunction <br> AND/OR <br> Myocardial injury (Troponin +)| B03= '''Low-risk PE''' <br> ''(also know as non-massive PE)'' <br> No shock <br> AND <br> No hypotension <br> AND <br> No right ventricular dysfunction <br> AND <br> No myocardial injury (Troponin -)}} | ||
{{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | | | }} | {{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?'''}} | {{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?'''}} | ||
Revision as of 18:22, 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 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Fibrinolytic therapy | Surgical pulmonary embolectomy OR Percutaneous catheter embolectomy | ||||||||||||||||||||||||||||||||||||||||||||||||