Emergency & Critical Medicine » Common Emergencies

Pulmonary embolism

Pulmonary embolism (PE) or pulmonary thromboembolism is not a disease in and of itself. Rather, it is an often fatal complication of underlying venous thrombosis. Patients who have undergone gynaecologic surgery, those with major trauma, and those with indwelling venous catheters may have DVTs that start at any location. For other patients, lower extremity venous thrombosis nearly always starts in the calf veins, which are involved in virtually 100% of all cases of symptomatic spontaneous lower extremity DVT. Immediate full anticoagulation is mandatory for all patients suspected to have DVT or PE. Initial anticoagulation is performed with intravenous heparin. The patient should be started simultaneously on oral anticoagulation with warfarin. After a therapeutic dose of warfarin is established, heparin is discontinued and warfarin therapy is maintained. Thrombolytic therapy should be considered for patients who are haemodynamically unstable, patients who have right-heart strain, and high-risk patients with underlying poor cardiopulmonary reserve.

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