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| | ==Overview== |
| {{familytree | | | | | | | A00 | | | | | | | | | A00=<div style="width:22em">'''Identify cardinal findings that increase the pretest probability of pulmonary embolism'''</div><br><div style="width:22em; text-align:left">
| | An abdominal aortic aneurysm is a localized dilatation of the [[abdominal aorta]], that exceeds the normal diameter of the [[abdominal aorta]] by more than 50%. The normal diameter of an [[aorta]] depends on the patient's age, sex, height, weight, race, body surface area, and baseline [[blood pressure]]. On average, the normal diameter of the infrarenal aorta is 2 cm, and therefore a true AAA measures 3.0 cm or more. Aortic ectasia is a mild generalized dilatation (<50% of the normal diameter of ≤ 2.9 cm) that is due to age-related degenerative changes in the vessel walls |
| ❑ Dyspnea at rest or with exertion <br>
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| ❑ [[Pleuritic pain]] <br>
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| ❑ [[Cough]] <br>
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| ❑ [[Tachycardia]]<br>
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| ❑ Accentuated P2 <br>
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| ❑ [[Wheezing]] <br>
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| ❑ [[Tachypnea]] <br>
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| ❑ [[Syncope]] <br>
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| ❑ Decreased breath sounds<br>
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| ❑ Calf or thigh pain and swelling <br>
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| ❑ Edema, erythema, tenderness, or a palpable cord in the calf or thigh
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| ❑ Recurrent miscarriage in a previously pregnant female</div> }}
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| {{familytree | | | | | | | |!| | | | | | | | | | }}
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| {{familytree | | | | | | | A01 | | | | | | | | | | A01= <div style="text-align: left; width: 18em; padding: 1em;">'''Does the patient have any of the following findings of massive pulmonary embolism that require urgent management?'''<br>
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| ❑ [[Dyspnea|>2- Pillow orthopnea]] <br> ❑ [[Hypotension]]<br> ❑ [[Jugular venous distension ]]<br> ❑ [[Right-sided S3]]<br>❑ [[Parasternal lift]]<br>
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| ❑ EKG demonstrates,<br>
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| :❑ Atrial arrhythmias <br>
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| :❑ Right bundle branch block<br>
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| :❑ Inferior Q-waves<br>
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| :❑ Precordial T-wave inversion and ST-segment changes
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| ❑ ABG shows,<br>
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| :❑ Hypercapnia <br>
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| :❑ Combined respiratory and metabolic acidosis</div>}}
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| {{familytree | | | | |,|-|-|^|-|-|.| | | | |}}
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| {{familytree |boxstyle= padding: 0; background: #FA8072; text-align: center;| | | | B01 | | | | | B02 | | | |B01={{fontcolor|#F8F8FF|'''Yes'''}}| B02=<div style="text-align: center; background: #FFFFFF; height: 25px; line-height: 25px;">'''No'''</div>}}
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| {{familytree | | | | |!| | | | | |!| }}
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| {{familytree |boxstyle= padding: 0; background: #FA8072; text-align: center;| | | | C01 | | | | | C02 | C01=<div style="padding: 5px; text-align: left; color: #F8F8FF;">❑ Perform D-dimer<br>
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| :❑ Erythrocyte agglutination assay (takes upto 2 min) <br>
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| :❑ Semi-quantitative latex agglutination assay (takes upto 5 min)<br>
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| :❑ Semi-quantitative rapid ELISA (takes upto 10 min)<br>
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| :❑ Qualitative rapid ELISA (takes upto 10 min)<br>
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| :❑ Quantitative latex agglutination assay (takes upto 15 min)<br>
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| :❑ Quantitative rapid ELISA (takes upto 30 min)
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| ❑ V/Q scan
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| </div>| C02=<div style="text-align: center; background: #FFFFFF; height: 77px; line-height: 30px; padding: 5px;">'''Proceed to the<br>[[Pulmonary embolism resident survival guide#Complete Diagnostic Approach| complete diagnostic approach]] below'''</div> }}
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| {{familytree | |,|-|-|+|-|-|-|-|.| | | | | | |}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| H01| |H02 | | H03 | | | | | | | | | | | H01=<div style=" text-align: center; width:15em">'''[[PE confirmed if]]'''</div><br><div style=" text-align: left">❑ High clinical probability with high-probability V/Q scan has 95% chance of having PE
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| </div>|H02=<div style=" text-align: center; width:15em">'''PE can not be excluded'''</div><br><div style=" text-align: left"> ❑ D-dimer level >500 ng/mL</div> |H03= <div style=" text-align: center; width: 15em">PE excluded</div> <br><div style=" text-align: left"> ❑ Normal V/Q scan <br>
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| ❑ Low clinical probability with low-probability V/Q scan has 4% chance of having PE <br>
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| ❑ D-dimer level <500 ng/mL excludes the diagnosis in low pretest probability
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| </div>}}
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| {{familytree | |!| | |!| | | | | |!| | | | | | | }}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| J01| |J02 | | J03 | | | | | | | | | | | J01= <div style=" background: #FA8072; text-align: left; width: 15em">Proceed with the management</div>| J02= <div style=" background: #FA8072; text-align: left; width: 15em">Perform [[Pulmonary embolism other imaging findings#Angiography|CT Pulmonary angiography]] to confirm the diagnosis of PE</div> | J03=<div style=" background: #FA8072; text-align: left; width: 15em">'''Proceed to the<br>[[Pulmonary embolism resident survival guide#Complete Diagnostic Approach| complete diagnostic approach]] below'''</div>}}
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| {{familytree | |L|V|~|J| | | | | | | | | | | |}}
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| {{familytree | | |K| | | | | | | | | | | | | |K ='''Assess for presence of anticoagulation contraindication'''
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| ❑ Major bleeding diathesis (e.g. coagulation defects, platelet count < 40,000) <br>
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| ❑ Uncontrollable active bleeding state <br>
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| ❑ Acute haemorrhagic stroke <br>
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| ❑ Cerebral lesions at high risk of bleeding <br>
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| ❑ Active ulcerative or angiodysplastic gastrointestinal disease <br>
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| ❑ Proliferative diabetic retinopathy <br>
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| ❑ Severe uncontrolled hypertension <br>
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| ❑ Severe renal and/or hepatic dysfunction}}
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| {{familytree | |,|^|-|.| | | | | | | | | | | |}}
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| {{familytree |boxstyle= padding: 0; background: #FA8072; text-align: center;|L01| | L02| | | | | | | | | | | | | |L01={{fontcolor|#F8F8FF|'''Yes'''}}| L02=<div style="text-align: center; background: #FFFFFF; height: 25px; line-height: 25px;">'''No'''</div>}}
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| {{familytree | |!| | | |!| | | | | | | | | | |}}
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| {{familytree |boxstyle= padding: 0; background: #FA8072; text-align: center;|M01| | M02| | | | | | | | | | | | | |M01={{fontcolor|#F8F8FF|'''[[IVC filter]]'''}}| M02=<div style="text-align: center; background: #FFFFFF; height: 25px; line-height: 25px;">'''Start Anticoagulation'''</div>}}
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| {{familytree | | | |,|-|^|-|.| | | | | | | | |}}
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| {{familytree | | |N01| |N02| | | | | | | | | N01='''[[Pulmonary embolism classification scheme#Submassive Pulmonary Embolism|Submassive PE]]'''|N02='''[[Pulmonary embolism classification scheme#Massive Pulmonary Embolism|Massive PE]]''' }}
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| {{familytree | | | |!| | | |!| | | | | | | | |}}
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| {{familytree | | | |!| | | |!| | | | | | | | |}}
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| {{familytree | | |B3 | | |!| | | | | | | | |B3='''Assess clinically for evidence of increased severity'''}}
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| {{familytree | | | |!| | | |!| | | | | | | | |}}
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| {{familytree | | |B4|-|C4| |B4='''Evidence of shock (SBP <90 mmHg) or respiratory failure''' |C4='''Is [[thrombolytic]] contraindicated?'''}}
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| {{familytree | | | | | |,|-|^|-|.| | | | | | |}}
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| {{familytree | | | | |JOE| |SIS|JOE='''Yes'''|ME=Inconclusive study|SIS='''No'''}}
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| {{familytree | | | | | |!| | | |!| | | | | | |}}
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| {{familytree | | | | |SIS| |B02|SIS='''[[Pulmonary thrombectomy|Surgical emblectomy]]''' or '''[[Pulmonary embolism catheter based interventions|catheter based interventions]]'''|B02='''Hold [[anticoagulation]], give [[thrombolytics]] then resume [[anticoagulations]]'''}}
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| {{familytree | | | | | | | | | |!| | | | | | |}}
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| {{familytree | | | | | | | | |SIS|SIS=Patient shows clinical improvement}}
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| {{familytree | | | | | | | | |,|^|-|-|.| | | |}}
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| {{familytree | | | | | | | |JOE| |SIS|JOE='''No'''|ME=Inconclusive study|SIS='''Yes'''}}
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| {{familytree | | | | | | | | |!| | | |!| | | |}}
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| {{familytree | | | | | | | |SIS| |B02|SIS='''[[Pulmonary thrombectomy|Surgical emblectomy]]''' or '''[[Pulmonary embolism catheter based interventions|catheter based interventions]]'''|B02='''Continue anticoagulation'''}}
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| {{familytree | | | | | | | | | A01 | | | | | | | | | | | |}}
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| {{familytree | | | | | | C01 | | | | C02 | | | | | | | | | | |}}
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| {{familytree | | | |,|-|-|^|-|-|.| | |!| | | |}}
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| {{familytree | | | D01 | | | | D02 | | | D03 | | | |}}
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| {{familytree | | | F01 | | | | F02 | | | F03| | | |}}
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| {{familytree/end}}
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Overview
An abdominal aortic aneurysm is a localized dilatation of the abdominal aorta, that exceeds the normal diameter of the abdominal aorta by more than 50%. The normal diameter of an aorta depends on the patient's age, sex, height, weight, race, body surface area, and baseline blood pressure. On average, the normal diameter of the infrarenal aorta is 2 cm, and therefore a true AAA measures 3.0 cm or more. Aortic ectasia is a mild generalized dilatation (<50% of the normal diameter of ≤ 2.9 cm) that is due to age-related degenerative changes in the vessel walls