DVT complete diagnostic approach resident survival guide: Difference between revisions
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{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | | | | | | | | | A00 | | | | | A00= '''Does the patient who is suspected to have PE have hypotension or shock?'''}} | {{familytree | | | | | | | | | | | | | | | | A00 | | | | | A00= '''Does the patient who is suspected to have PE have [[hypotension]] or [[shock]]?'''}} | ||
{{familytree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| }} | {{familytree | | | | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| }} | ||
{{familytree | | | | | | | A01 | | | | | | | | | | | | | | | | | A02 | A01= Yes| A02= No}} | {{familytree | | | | | | | A01 | | | | | | | | | | | | | | | | | A02 | A01= Yes| A02= No}} | ||
| Line 6: | Line 6: | ||
{{familytree | | | | | | | A02 | | | | | | | | | | | | | | | | | A03 | A02= '''Suspected high-risk PE'''| A03= '''Suspected non-high risk PE'''}} | {{familytree | | | | | | | A02 | | | | | | | | | | | | | | | | | A03 | A02= '''Suspected high-risk PE'''| A03= '''Suspected non-high risk PE'''}} | ||
{{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | |!| }} | {{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | |!| }} | ||
{{familytree | | | | | | | A04 | | | | | | | | | | | | | | | | | |!| A04= ''Administer anticoagulation'' <br>''(in case there are no contraindications)''<br>''during the diagnostic workup''}} | {{familytree | | | | | | | A04 | | | | | | | | | | | | | | | | | |!| A04= ''Administer [[anticoagulation]]'' <br>''(in case there are no contraindications)''<br>''during the diagnostic workup''}} | ||
{{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | |!| }} | {{familytree | | | | | | | |!| | | | | | | | | | | | | | | | | | |!| }} | ||
{{familytree | | | | | | | B01 | | | | | | | | | | | | | | | | | B02| B01= '''Is a CT available immediately?'''| B02= '''What is the pretest probability of PE?''' <br> Assess the pretest probability of PE<br> by using one of the risk score:<br> - [[Wells score]] <br> - [[Geneva score]] <br> - [[PERC]]}} | {{familytree | | | | | | | B01 | | | | | | | | | | | | | | | | | B02| B01= '''Is a [[CT]] available immediately?'''| B02= '''What is the pretest probability of PE?''' <br> Assess the pretest probability of PE<br> by using one of the risk score:<br> - [[Wells score]] <br> - [[Geneva score]] <br> - [[PERC]]}} | ||
{{familytree | | | |,|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | |,|-|v|-|^|-|-|.| | }} | {{familytree | | | |,|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | |,|-|v|-|^|-|-|.| | }} | ||
{{familytree | | | C01 | | | | | | | | | | C02 | | | | | |!| |!| | | | |!| | C01= No| C02= Yes}} | {{familytree | | | C01 | | | | | | | | | | C02 | | | | | |!| |!| | | | |!| | C01= No| C02= Yes}} | ||
| Line 14: | Line 14: | ||
{{familytree | | | D01 | | | | | | | | | | |!| | | | | | |!| |!| | | | |!| | D01= Order [[echocardiography]]}} | {{familytree | | | D01 | | | | | | | | | | |!| | | | | | |!| |!| | | | |!| | D01= Order [[echocardiography]]}} | ||
{{familytree | | | |!| | | | | | | | | | | |!| | | | | | |!| |!| | | | |!| | }} | {{familytree | | | |!| | | | | | | | | | | |!| | | | | | |!| |!| | | | |!| | }} | ||
{{familytree | | | E01 | | | | | | | | | | |!| | | | | E02 | | E03 | | E04 | E01= '''Does the patient have RV overload?'''| E02= '''Low pretest probability''' |E03= '''Intermediate pretest probability'''| E04= '''High pretest probability''' <br>OR<br> '''PE is likely'''}} | {{familytree | | | E01 | | | | | | | | | | |!| | | | | E02 | | E03 | | E04 | E01= '''Does the patient have [[RV]] overload?'''| E02= '''Low pretest probability''' |E03= '''Intermediate pretest probability'''| E04= '''High pretest probability''' <br>OR<br> '''PE is likely'''}} | ||
{{familytree | | | |!| | | | | | | | | | | |!| | | | | | |!| |!| | | | |!| }} | {{familytree | | | |!| | | | | | | | | | | |!| | | | | | |!| |!| | | | |!| }} | ||
{{familytree | | | |!| | | | | | | | | | | |!| | | | | | |!| | N01 | | N02 | N01= Administer anticoagulation <br>(in case there are no contraindications)<br>during the diagnostic workup|N02= Administer anticoagulation <br>(in case there are no contraindications)<br>during the diagnostic workup}} | {{familytree | | | |!| | | | | | | | | | | |!| | | | | | |!| | N01 | | N02 | N01= ''Administer [[anticoagulation]]'' <br>''(in case there are no contraindications)''<br>''during the diagnostic workup''|N02= ''Administer [[anticoagulation]]'' <br>''(in case there are no contraindications)''<br>''during the diagnostic workup''}} | ||
{{familytree | |,|-|^|-|-|-|.| | | | | | | |!| | | | | | |!| |!| | | | |!| | }} | {{familytree | |,|-|^|-|-|-|.| | | | | | | |!| | | | | | |!| |!| | | | |!| | }} | ||
{{familytree | F01 | | | | F02 | | | | | | F03 | | | | | | F04 | | | | |!| F01= No| F02= Yes| F03= Order CT| F04= '''Order D-dimer'''}} | {{familytree | F01 | | | | F02 | | | | | | F03 | | | | | | F04 | | | | |!| F01= No| F02= Yes| F03= '''Order [[CT]]'''| F04= '''Order [[D-dimer]]'''}} | ||
{{familytree | |!| | | | | |!| | | | | |,|-|^|-|.| | | |,|-|^|-|.| | | |!| }} | {{familytree | |!| | | | | |!| | | | | |,|-|^|-|.| | | |,|-|^|-|.| | | |!| }} | ||
{{familytree | |!| | | | | |!| | | | | G02 | | G03 | | G04 | | G05 | | |!| G01= | G02= Positive| G03= Negative| G04= Positive| G05= Negative}} | {{familytree | |!| | | | | |!| | | | | G02 | | G03 | | G04 | | G05 | | |!| G01= | G02= Positive| G03= Negative| G04= Positive| G05= Negative}} | ||
{{familytree | |!| | | |,|-|^|-|.| | | |!| | | |!| | | |!| | | |!| | | |!| }} | {{familytree | |!| | | |,|-|^|-|.| | | |!| | | |!| | | |!| | | |!| | | |!| }} | ||
{{familytree | |!| | | H01 | | H02 | | |!| | | |!| | | H03 | | H04 | | H05 | | | H01= Is the patient unstable <br> OR<br> no other tests are available?| H02=Is the patient stabilized <br> AND <br> CT is now available?| H03= Order CT| H04= PE is excluded| H05= Order CT}} | {{familytree | |!| | | H01 | | H02 | | |!| | | |!| | | H03 | | H04 | | H05 | | | H01= Is the patient unstable <br> OR<br> no other tests are available?| H02=Is the patient stabilized <br> AND <br> CT is now available?| H03= Order CT| H04= PE is excluded| H05= '''Order [[CT]]'''}} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |)|-|-|-|.| | | |)|-|-|-|.| | }} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |)|-|-|-|.| | | |)|-|-|-|.| | }} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | L01 | | L02 | | L03 | | L04 | L01= Positive| L02= Negative| L03= Positive| L04= Negative}} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | L01 | | L02 | | L03 | | L04 | L01= Positive| L02= Negative| L03= Positive| L04= Negative}} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | ||
{{familytree | I01 | | I02 | | I03 | | I04 | | I05 | | I06 | | I07 | | I08 | | I09 | I01= PE is excluded| I02= Consider | {{familytree | I01 | | I02 | | I03 | | I04 | | I05 | | I06 | | I07 | | I08 | | I09 | I01= PE is excluded| I02= Consider [[thrombolytic therapy]] or [[embolectomy]]| I03= Order CT| I04= PE is confirmed| I05=PE is excluded| I06= PE is confirmed| I07= PE is excluded| I08= PE is confirmed| I09= PE is excluded}} | ||
{{familytree | | | | | | | |,|-|^|-|.| | | | }} | {{familytree | | | | | | | |,|-|^|-|.| | | | }} | ||
{{familytree | | | | | | | J01 | | J02 | | | J01= Positive for PE| J02= Negative for PE}} | {{familytree | | | | | | | J01 | | J02 | | | J01= Positive for PE| J02= Negative for PE}} | ||
Revision as of 19:28, 15 May 2014
| Does the patient who is suspected to have PE have hypotension or shock? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Suspected high-risk PE | Suspected non-high risk PE | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Administer anticoagulation (in case there are no contraindications) during the diagnostic workup | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Is a CT available immediately? | What is the pretest probability of PE? Assess the pretest probability of PE by using one of the risk score: - Wells score - Geneva score - PERC | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Order echocardiography | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Does the patient have RV overload? | Low pretest probability | Intermediate pretest probability | High pretest probability OR PE is likely | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Administer anticoagulation (in case there are no contraindications) during the diagnostic workup | Administer anticoagulation (in case there are no contraindications) during the diagnostic workup | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | Order CT | Order D-dimer | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive | Negative | Positive | Negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Is the patient unstable OR no other tests are available? | Is the patient stabilized AND CT is now available? | Order CT | PE is excluded | Order CT | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive | Negative | Positive | Negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PE is excluded | Consider thrombolytic therapy or embolectomy | Order CT | PE is confirmed | PE is excluded | PE is confirmed | PE is excluded | PE is confirmed | PE is excluded | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive for PE | Negative for PE | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| PE is confirmed | PE is excluded | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||