Pulmonary embolism in pregnancy - Revision history

Rossdonaldson1: /* Evaluation */

2024-11-13T18:44:20Z

Evaluation

← Older revision		Revision as of 18:44, 13 November 2024
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	==Evaluation==		==Evaluation==
	[[File:Pulm embolism.jpg\|thumb\|[[ECG]] of a person with pulmonary embolism, showing sinus tachycardia of approximately 100 beats per minute, large S wave in Lead I, moderate Q wave in Lead III, inverted T wave in Lead III, and inverted T waves in leads V1 and V3.]]		[[File:Pulm embolism.jpg\|thumb\|[[ECG]] of a person with pulmonary embolism, showing sinus tachycardia of approximately 100 beats per minute, large S wave in Lead I, moderate Q wave in Lead III, inverted T wave in Lead III, and inverted T waves in leads V1 and V3.]]
			[[File:SaddlePE.png\|thumb\|A large pulmonary embolism at the bifurcation of the pulmonary artery (saddle embolism).]]
	===Clinical Decision Rules===		===Clinical Decision Rules===
	'''YEARS Algorithm''' <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].		'''YEARS Algorithm''' <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].

Rossdonaldson1: /* Evaluation */

2024-11-13T18:43:41Z

Evaluation

← Older revision		Revision as of 18:43, 13 November 2024
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	==Evaluation==		==Evaluation==
			[[File:Pulm embolism.jpg\|thumb\|[[ECG]] of a person with pulmonary embolism, showing sinus tachycardia of approximately 100 beats per minute, large S wave in Lead I, moderate Q wave in Lead III, inverted T wave in Lead III, and inverted T waves in leads V1 and V3.]]
	===Clinical Decision Rules===		===Clinical Decision Rules===
	'''YEARS Algorithm''' <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].		'''YEARS Algorithm''' <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].

Rossdonaldson1: /* Clinical Features */

2024-11-13T18:43:06Z

Clinical Features

← Older revision		Revision as of 18:43, 13 November 2024
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	==Clinical Features==		==Clinical Features==
			[[File:Deep vein thrombosis of the right leg.jpg\|thumbnail\|DVT of right leg]]
	{{PE clinical presentation}}		{{PE clinical presentation}}

Rossdonaldson1 at 18:42, 13 November 2024

2024-11-13T18:42:40Z

← Older revision		Revision as of 18:42, 13 November 2024
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	==Background==		==Background==
			[[File:Computed tomograph of pulmonary vessels.jpg\|thumb\|Pulmonary emboli can be classified according to the level along the pulmonary arterial tree.]]
	*Incidence of [[VTE]] in pregnancy and postpartum is 1.72 per 1000<ref>James AH, et al. Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors, and mortality. 2006; 194(5):1311–1315.</ref>		*Incidence of [[VTE]] in pregnancy and postpartum is 1.72 per 1000<ref>James AH, et al. Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors, and mortality. 2006; 194(5):1311–1315.</ref>
	*Risk significantly elevated in the 6 weeks postpartum		*Risk significantly elevated in the 6 weeks postpartum

Rossdonaldson1: /* Clinical Decision Rules */

2024-11-06T16:21:42Z

Clinical Decision Rules

← Older revision		Revision as of 16:21, 6 November 2024
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	'''YEARS Algorithm''' <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].		'''YEARS Algorithm''' <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].

	Appears to be possible viable clinical decision tool to rule out PE in pregnant patients		''Appears to be possible viable clinical decision tool to rule out PE in pregnant patients''

	Utilizes D-dimer and presence/absence of three YEARS criteria: (1) clinical signs of DVT, (2) hemoptysis, (3) PE as most likely diagnosis''		Utilizes D-dimer and presence/absence of three YEARS criteria: (1) clinical signs of DVT, (2) hemoptysis, (3) PE as most likely diagnosis''

Azhandos: /* Clinical Decision Rules */

2024-10-31T18:28:58Z

Clinical Decision Rules

← Older revision		Revision as of 18:28, 31 October 2024
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	==Evaluation==		==Evaluation==
	===Clinical Decision Rules===		===Clinical Decision Rules===
	*YEARS Algorithm ~~appears to be possible viable clinical decision tool to rule out PE in pregnant patients~~ <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].		'''YEARS Algorithm''' <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].
	**utilizes d dimer ~~test~~ and presence of three YEARS criteria: clinical signs of DVT, hemoptysis, PE as most likely diagnosis
	**clinical sign of DVT ~~with positive~~ US LE, initiate anticoagulant treatment		Appears to be possible viable clinical decision tool to rule out PE in pregnant patients
	**~~clinical sign of DVT with negative~~ US LE~~, into~~ algorithm
	**No YEARS criteria ~~with d~~ dimer <~~1000~~, PE ~~ruled out~~		Utilizes D-dimer and presence/absence of three YEARS criteria: (1) clinical signs of DVT, (2) hemoptysis, (3) PE as most likely diagnosis''
	**No YEARS criteria ~~with d dimer >1000~~, ~~CTA~~
	**1-~~3 YEARS criteria with d~~ dimer <500, PE ~~ruled out~~		*Clinical signs of DVT? If yes, obtain LE US to rule out DVT:
	**1-3 YEARS ~~criteria with d dimer >500 , CTA~~		**Positive US LE ➟ initiate anticoagulant treatment
			**Negative US LE ➟ continue algorithm
			*Zero YEARS criteria ('''no''' signs of DVT, '''no''' hemoptysis, PE is '''not''' most likely diagnosis):
			**D-dimer <1,000 ng/mL FEU ➟ PE excluded
			**D-dimer ≥1,000 ng/mL FEU ➟ PE not excluded (YEARS algorithm recommends CTPA)
			*Presence of ≥1 YEARS criteria (signs of DVT, hemoptysis, and/or PE is most likely diagnosis):
			**D-dimer <500 ng/mL FEU ➟ PE excluded
			**D-dimer ≥500 ng/mL FEU ➟ PE not excluded (YEARS algorithm recommends CTPA)

	===If clinical features suggestive of [[PE]] and lower extremity swelling===		===If clinical features suggestive of [[PE]] and lower extremity swelling===

Hoxbox: /* Clinical Decision Rules */

2019-12-03T14:33:35Z

Clinical Decision Rules

← Older revision		Revision as of 14:33, 3 December 2019
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	==Evaluation==		==Evaluation==
	===Clinical Decision Rules===		===Clinical Decision Rules===
	*YEARS Algorithm appears to be possible viable clinical decision tool to rule out PE in pregnant patients <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc ~~Link~~]		*YEARS Algorithm appears to be possible viable clinical decision tool to rule out PE in pregnant patients <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc link].
	**utilizes d dimer test and presence of three YEARS criteria: clinical signs of DVT, hemoptysis, PE as most likely diagnosis		**utilizes d dimer test and presence of three YEARS criteria: clinical signs of DVT, hemoptysis, PE as most likely diagnosis
	**clinical sign of DVT with positive US LE, initiate anticoagulant treatment		**clinical sign of DVT with positive US LE, initiate anticoagulant treatment

Hoxbox: /* Clinical Decision Rules */

2019-12-03T14:33:03Z

Clinical Decision Rules

← Older revision		Revision as of 14:33, 3 December 2019
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	==Evaluation==		==Evaluation==
	===Clinical Decision Rules===		===Clinical Decision Rules===
	*YEARS Algorithm appears to be possible viable clinical decision tool to rule out PE in pregnant patients <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>		*YEARS Algorithm appears to be possible viable clinical decision tool to rule out PE in pregnant patients <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>. [https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe MDCalc Link]
	**utilizes d dimer test and presence of three YEARS criteria: clinical signs of DVT, hemoptysis, PE as most likely diagnosis		**utilizes d dimer test and presence of three YEARS criteria: clinical signs of DVT, hemoptysis, PE as most likely diagnosis
	**clinical sign of DVT with positive US LE, initiate anticoagulant treatment		**clinical sign of DVT with positive US LE, initiate anticoagulant treatment

Gregtong: /* Clinical Decision Rules */

2019-08-21T03:52:42Z

Clinical Decision Rules

← Older revision		Revision as of 03:52, 21 August 2019
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	*YEARS Algorithm appears to be possible viable clinical decision tool to rule out PE in pregnant patients <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>		*YEARS Algorithm appears to be possible viable clinical decision tool to rule out PE in pregnant patients <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>
	**utilizes d dimer test and presence of three YEARS criteria: clinical signs of DVT, hemoptysis, PE as most likely diagnosis		**utilizes d dimer test and presence of three YEARS criteria: clinical signs of DVT, hemoptysis, PE as most likely diagnosis
			**clinical sign of DVT with positive US LE, initiate anticoagulant treatment
			**clinical sign of DVT with negative US LE, into algorithm
			**No YEARS criteria with d dimer <1000, PE ruled out
			**No YEARS criteria with d dimer >1000, CTA
			**1-3 YEARS criteria with d dimer <500, PE ruled out
			**1-3 YEARS criteria with d dimer >500 , CTA

	===If clinical features suggestive of [[PE]] and lower extremity swelling===		===If clinical features suggestive of [[PE]] and lower extremity swelling===

Gregtong: /* Clinical Decision Rules */

2019-08-21T03:49:08Z

Clinical Decision Rules

← Older revision		Revision as of 03:49, 21 August 2019
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	===Clinical Decision Rules===		===Clinical Decision Rules===
	*YEARS Algorithm appears to be possible viable clinical decision tool to rule out PE in pregnant patients <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>		*YEARS Algorithm appears to be possible viable clinical decision tool to rule out PE in pregnant patients <ref> van der Pol LM et al. Pregnancy-Adapted YEARS Algorithm for diagnosis of Suspected Pulmonary Embolism. NEJM 2019; 380(12): 1139-49 </ref>
			**utilizes d dimer test and presence of three YEARS criteria: clinical signs of DVT, hemoptysis, PE as most likely diagnosis

	===If clinical features suggestive of [[PE]] and lower extremity swelling===		===If clinical features suggestive of [[PE]] and lower extremity swelling===