Acute pulmonary embolism: diagnostic algorithms Alexandre GHUYSEN Service des Urgences - CHU Liège Symposium Belge des Médecins de l’Urgence Bruxelles, le 16 janvier 2010 Take home messages

Initial Risk Stratification for Pulmonary Embolism Suspected acute PE Shock or hypotension * No Yes High risk Non high risk Different management strategies *defined as systolic BP 40 mmHg for > 15 min, if not cuased by new onset arythmia, hypovolemia or sepsis

Emergency Diagnostic Workup for Suspected Pulmonary Embolism in a Patient with Hypotension or Shock Konstantinides S. N Engl J Med 2008;359: Suspected high risk PE i.e with shock or hypotension CT immediately available Yes No Echocardiography Rv overload No Other causes Yes CT available Patient stabilized CT not available Patient unstable PE: treatment CT Other causes Negative Positive Eur Heart J 2008;29:

Diagnostic Algorithm for Suspected Pulmonary Embolism in a Patient without Hypotension or Shock Konstantinides S. N Engl J Med 2008;359: Suspected non high risk PE i.e. without shock or hypotension Assess clinical probability of PE Implicit or prediction rule PE unlikely: low/intermediate clinical probability PE likely high clinical probability D-Dimer assay no PE MD-CT No PE PE treatment no PE ( +US?) PE treatment - + Eur Heart J 2008;29: