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Pulmonary Embolism (General Measures (Correct hypoxemia (Respiratory…
Pulmonary Embolism
General Measures
Correct hypoxemia
O2
Respiratory insuficiency
Intubation
Hypotension
IV Fluids
Vasopressors
Analgesics and sedatives
Clinically Stable Patient
WELLS SCORE
Greater than 4
Anticoagulation
CTPA
DRUGS
Warfarin
Start with parenteral anticoag
overlap for >/= 5 days
Keep for 3-6 months
goal INR 2-3
To prevent another thrombus
Parenteral anticoag
LMWH
enoxa 1 mg/kg SC bid
Foundaparinoux
5-10 mg SC qid
IV UFH
80U/kg bolus → 18U/kg/h
Renal failure/ fibrinolysis candidates
Non vit K oral anticoag
Sole
Riva/apixa
15 mg PO bid x21 days
10 mg PO bid x7 days
Initiate >5 d of parental anticoag
Edox/dabi
30 mg PO qd
150 mg PO bid
Less than 4
D-Dimer
+
CTPA
-
Rules out
Clinically Unstable Patient
Ressuscitation
IV Fluids, vasopressors
Stable
Anticoagulation
CTPA
Unstable
Ecochardiography
Presumptive of PE
Thrombolysis