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Breathlessness, Investigations, Examination, Management - Coggle Diagram

- - - - Productive cough (green, yellow, rusty sputum)
  - - - Bloodstained sputum
  - - - Grass pollen
      - House dust mites
- - - - Nausea
      - Chest pain
  - - - Positional: relieved by leaning forwards
- - - - Sats <90%, give oxygen: target 94-98
    - - Includes:
        
        IV access
        
        Fluids: if systolic <90, 500ml over 15-30mins (0.9%NaCl or Hartmanns) = HAEMODYNAMICALLY INSTABILITY
        
        Leading cause of death in patients with high-risk PE
        
        Right heart failure so close monitoring for signs is important
        
        Analgesia: 5mg morphine (maybe 2.5 in older)
- - - - Hypoxaemia with normal or low carbon dioxide
    - - Hypoxaemia with high carbon dioxide due to inadequate ventilation
- - - - D-dimer test: results within 4 hours (interim anticoagulation if can’t get within 4 hours)
        
        If positive, arrange CTPA
        
        If negative, stop interim therapeutic anticoagulation
    - - Therapeutic anticoagulation and arrange CTPA
        
        Offer apixaban or rivaroxaban
        
        If neither suitable
        
        LMWH for at least 5 days (concurrently with vitamin K antagonists) followed by dabigatran or edoxaban
    - - Clinical features of deep vein thrombosis (DVT, leg swelling and pain with palpation of deep veins) = 3 points
      - Alternative diagnosis is less likely than PE = 3 points
      - HR >100 = 1.5 points
      - Immobilisation more than 3 days or surgery in past 4 weeks = 1.5 points
      - Previous DVT or PE = 1.5 points
      - Haemoptysis or cancer = both 1 point
- - - - Use restricted to clinical trials or PE occurred during anticoagulation treatment