Pulmonary embolism

Question 1

management?

Answer 1

the first step, in suspected patients, supportive care (oxygen, intravenous fluids for hypotension). sec step, assessing absolute contraindications to anticoagulation (ex: active bleeding, hemorrhagic stroke).
Patients with contraindications should undergo diagnostic testing for PE, with appropriate treatment (ex: inferior vena cava filter) if positive. patients without contraindications can be assessed with the modified wells criteria for PE pretest probability.
in patients in whom PE is unlikely based on these criteria, diagnostic testing is performed before anticoagulation is considered. as for patients with likely PE, anticoagulation ( low molecular weight heparin or unfractionated heparin) should be given prior to testing, especially in patients with moderate to severe distress.

Question 2

anticoagulation

Answer 2

can be safely administered ( started) within 6-12 hrs of a cesarean delivery.

Question 3

wells criteria

Answer 3

+3 clinical signs of DVT, alternate diagnosis less than PE. +1.5 previous PE or DVT, heart rate > 100, recent surgery or immobilization. +1 hemoptysis, cancer.
total score < or = 4 PE unlikely, >4 PE is likely.

Question 4

mortality risk

Answer 4

early and effective anticoagulation decreases the mortality risk of acute PE.