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Pulmonary embolism (Signs, symptoms and history (Elevated JVP (If core…
Pulmonary embolism
Signs, symptoms and history
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Signs of cause
Unilateral swelling, tenderness of calf
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Diagnosis/Investigations
Wells Criteria
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Cancer receiving active treatment, treated in last 6/12 or palliative
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Score <4 = PE unlikely
D-dimer test
If -ve, consider alternative diagnosis
If +ve (elevated), do immediate CTPA or empirical treatment LMWH
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Management
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- Commence LMWH/fondaparinux
- Haemodynamic instability (persistent hypotension)= consider thrombolysis with alteplase 10mg IV
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- Heamodynamically stable - commence long term anticoagulation (DOAC -immediate switch from LMWH OR warfarin - continue LMWH until INR>2
Alternatives to warfarin - rivaroxaban, apixaban. Do not require LMWH overlap
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