#Pulmonary_Embolism_5 #PE Diagnostic Algorithm for PE #_ES | "لعلي أفيدك" Clinical discussion

#Pulmonary_Embolism_5 #PE
Diagnostic Algorithm for PE #_ESC
هنقسم مرضى ال PE لقسمين :
Hemodynamic Stable suspected PE

Hemodynamic Unstable suspected PE



لو المريض Hemodynamic Stable
اول شي هنعمل Assess لل PE clinical probability
إما بال Revised Geneva rule او ال Well Score
ونحدد هل المريض PE Likely ولا PE Unlikely

pt with PE Unlikely or( Low -Intermediate PE probability)
ال next step في التشخيص هيكون ال D-Dimer
لو ال D-Dimer كان Negative يبقى PE Roled out
لو ال D-Dimer كان positive بنعمل للمريض CTPA
وحسب ال CTPA بنشوف
لو CTPA كان Positive يبقى PE Confirmed
لو Negative يبقى PE Unlikely

Note : As an alternative to the fixed D-dimer cut-off, a negative D-dimer test using an age-adjusted cut-off (age x 10 µg/L, in patients aged >50 years) should be considered for excluding PE in patients with low or intermediate clinical probability or those that are PE-unlikely

Pt with PE Likely or ( High PE probability Score)

هنا ال next step هي ال CTPA
لو positive يبقى PE Confirmed
لو Negative ما بنعالج ك PE وبنشوف Further Investigation



لو المريض Hemodynamic Unstable
فال 1st step هو ال Bedside TTE
If pt showed to has RV dysfunction in TTE
لو في RV dysfunction ف بنعمل CTPA
لو ال CTPA كان positive يبقى PE Confirmed
لو ال CTPA كان negative بندور على سبب تاني لل shock

لو ال TTE أظهر RV dysfunction ومش متوفر ال CTPA
فاعتبر المريض PE وعالج على انه PE

If pt with No RV dysfunction in TTE
Search for other Cause of Shock and Instability

#لعلي_أفيدك