Clinical policy: Critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism Annals of Emergency.

Slides:

Advertisements

Similar presentations

The PERC Rule. The paper Kline et al Journal of Thrombosis and Haemostasis 2008 Prospective Multicenter Evaluation of the Pulmonary Embolism Rule Out.

Advertisements

Young Woman With Abdominal Pain David Jones, MD Annals of Emergency Medicine Volume 64, Issue 4, (October 2014) DOI: /j.annemergmed

Many Emergency Department Patients With Severe Sepsis and Septic Shock Do Not Meet Diagnostic Criteria Within 3 Hours of Arrival Julian Villar, MD, MPH,

Asad Mehdi, MD. Outline A Diagnostic Approach to Pulmonary Embolism Clinical Presentation Risk Stratification Wells Criteria Geneva Rule PIOPED Approach.

Date of download: 9/17/2016 From: Topical Treatment of Pressure Ulcers with Nerve Growth Factor: A Randomized Clinical Trial Ann Intern Med. 2003;139(8):

Ann Intern Med. 2011;155(7): doi: / Figure Legend:

Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act Scott M. Dresden, MD, MS, Emilie.

Ann Intern Med. 2005;143(6): doi: / Figure Legend: Flow of evidence.

From: Wells Rule and d-Dimer Testing to Rule Out Pulmonary EmbolismA Systematic Review and Individual-Patient Data Meta-analysis Ann Intern Med. 2016;165(4):

Annals of Emergency Medicine

Mark Tulchinsky, M.D., Jack A. Zeller, M.D., Richard C. Reba, M.D.

Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Pulmonary Embolism Francis M.

Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients With Allergic Reactions or Anaphylaxis Brian E. Grunau, MD, Jennifer.

Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD

Many Emergency Department Patients With Severe Sepsis and Septic Shock Do Not Meet Diagnostic Criteria Within 3 Hours of Arrival Julian Villar, MD, MPH,

Global Emergency Medicine Journal Club: A Social Media Discussion About the Age- Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism Trial Salim.

No SIRS; Quick SOFA Instead

Alan E. Jones, MD, Michael A. Puskarich, MD

The Characteristics and Outcomes of Patients Who Make an Emergency Department Visit for Hypertension After Use of a Home or Pharmacy Blood Pressure Device

A Sample Rule-Out Tuberculosis Protocol

Annals of Emergency Medicine

Progressive Foot Swelling and Pain

Jennifer J. Lee, MD, FAAD, Renee Y. Hsia, MD, MSc

Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department Annals of Emergency Medicine Volume.

Managing Nontraumatic Acute Back Pain

Fatal Cerebral Edema After Moderate Valproic Acid Overdose

Infant Male With Blood-Colored Stools

Clinician Gestalt Estimate of Pretest Probability for Acute Coronary Syndrome and Pulmonary Embolism in Patients With Chest Pain and Dyspnea Jeffrey.

Observers in the Medical Setting

Steven M. Green, MD, Mark G. Roback, MD, Robert M

Elderly Male With Cheek Swelling

Middle-Aged Man With Rash

Clinical Utility of Likelihood Ratios

Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients With Allergic Reactions or Anaphylaxis Brian E. Grunau, MD, Jennifer.

Short-Bowel Syndrome Clinical Gastroenterology and Hepatology

Andrea W. Thorp, MD, David L. Schriger, MD, MPH

Sangeeta Lamba, MD, Tammie E. Quest, MD Annals of Emergency Medicine

Bilateral Knee Deformity Following a Fall

Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms Ram.

Woman With Leg Rash Annals of Emergency Medicine

Adult Female With Malignant Pain

Calendar Annals of Emergency Medicine

An Elderly Woman with Arm Twitching

Clinical Features From the History and Physical Examination That Predict the Presence or Absence of Pulmonary Embolism in Symptomatic Emergency Department.

Nupur Garg, MD, Michael Gottlieb, MD Annals of Emergency Medicine

Newborn With a Rash Annals of Emergency Medicine

Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Non–ST-Segment Elevation Acute Coronary Syndromes Francis M.

Emergency Department Planning and Resource Guidelines

Outpatient Pulmonary Embolism Management: If You Walk Into the Emergency Department With a Pulmonary Embolism, Maybe You Should Also Walk Out Tyler W.

Eric Berger Annals of Emergency Medicine

Woman With Hip Pain Annals of Emergency Medicine

Body Cameras in the Emergency Department

Revisiting the “Golden Hour”: An Evaluation of Out-of-Hospital Time in Shock and Traumatic Brain Injury Craig D. Newgard‎, MD, MPH, Eric N. Meier, MS,

Classified Advertising

Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Suspected Pulmonary Embolism Francis M.

Benjamin Easter, MD, Jennie A. Buchanan, MD

Chad Kessler, MD, MHPE, Nathaniel L

Kuo-Chen Cheng, MD Annals of Emergency Medicine

Images in Emergency Medicine

Images in Emergency Medicine

Clots in the lung Annals of Emergency Medicine

Images in Emergency Medicine

Woman With Unresponsiveness

Comparison of the Unstructured Clinician Gestalt, the Wells Score, and the Revised Geneva Score to Estimate Pretest Probability for Suspected Pulmonary.

Lean Thinking in Emergency Departments: A Critical Review

Volume 134, Issue 2, Pages (August 2008)

CTA chest use in ED to fish for PEs

Images in Emergency Medicine

D. Stevenson, T. Long, J.P. Green, J. Rose

Clots in the lung Annals of Emergency Medicine

Presentation transcript:

Clinical policy: Critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism Annals of Emergency Medicine Volume 41, Issue 2, Pages 257-270 (February 2003) DOI: 10.1067/mem.2003.40 Copyright © 2003 American College of Emergency Physicians Terms and Conditions

Figure. Kline et al43 decision rule for excluding PE Figure. Kline et al43 decision rule for excluding PE. Reprinted with permission from Kline JA, Nelson RD, Jackson RE, et al. Criteria for the safe use of D -dimer testing in emergency department patients with suspected pulmonary embolism: a multicenter US study. Ann Emerg Med. 2002;39:144-152. Flow diagram demonstrating how the decision rule works to determine whether a patient can have PE ruled out with either a negative D -dimer plus alveolar deadspace measurement or a quantitative D -dimer assay of <500 ng/mL (either procedure hereafter referred to as D-dimer testing). First, any ED patient with any degree of suspicion for PE can be considered. Next, if the patient is ≤50 years of age and the heart rate is less than or equal to the systolic blood pressure (ie, shock index ≤1.0), the patient is immediately eligible for D-dimer testing. If the patient is either >50 years or has a shock index of >1.0, the clinician should ask 4 sequential questions: (1) Does the patient have unexplained hypoxemia? (2) Does the patient have unilateral leg swelling? (3) Has the patient had surgery requiring general anesthesia in the past 4 weeks? (4) Does the patient have hemoptysis? If the answer to all 4 questions is “no,” then the patient is still eligible for D-dimer testing. This decision rule splits the patients into 2 groups: four fifths of whom are eligible for D-dimer testing (“safe” patients with pretest probability of PE of 13.3%) and one fifth of whom are ineligible for D-dimer testing (“unsafe” patients with pretest probability of 42.1%). Annals of Emergency Medicine 2003 41, 257-270DOI: (10.1067/mem.2003.40) Copyright © 2003 American College of Emergency Physicians Terms and Conditions