Diagnostic features
 

O2 and CO2 on ABGs (normal results do not exclude PE)

ECG: sinus tachycardia, S1Q3T3, RBBB

CXR: atelectasis, oligaemic defect, pleurel effusion, consolidation

D-Dimer can help to exclude the diagnosis if negative

A negative D-Dimer plus PaO2>10.7 kPa can virtually exclude the diagnosis

Treatment should be started prior to confirming diagnosis by V/Q, CT or
   angiography if clinical suspicion & initial tests are suggestive


Treatment

 

GIVE high concentration oxygen

MONITOR ECG, SpO2, BP

RELIEVE chest pain + anxiety with regular IV opiate

Haemodynamically STABLE give

Enoxaparin 1.5mg/kg SC every 24 hours

Haemodynamically UNSTABLE give thrombolysis

Streptokinase 250 000 units IV over 20-30 mins followed by 100 000 units/hr for up to 24 hrs

The use of Alteplase (r-TPA) with concurrent heparin is not aproved locally


If thrombolysis fails or is contradicted, refer to cardiothoracic
surgeons for surgical / catheter embolectomy


Adapted from Frimley Park Hospital guidelines

(C) 2001 Crown. All rights reserved