Is It a PE?
Lets walk through the dx steps
Pathway to diagnosing PE:
PERC: PE rule-out criteria
Done when you think there is a low pre-test probability of PE but want reassurance.
If all of the below are negative than likelihood of PE is <2%
If you have even the smallest suspicion, then move on to the 2 level PE wells score test without doing PERC.
All of the above must be absent to have a negative PERC test
2 level PE Wells score
Carry out PE wells score test
PE likely if > 4. PE Unlikely if 4 or less
IF LIKELY:
Arrange CTPA (Computed Tomography Pulmonary Angiogram)
If there will be a delay in CTPA, then start DOACs such as apixaban or rivaroxaban
If CTPA is + then PE is the diagnosis
If CTPA is - then consider proximal leg US if DVT is suspected
IF UNLIKELY:
Arrange D-dimer test
If + arrange CTPA then follow the above steps from the LIKELY section
If - PE is unlikely, stop anticoagulation and consider alternative dx
https://www.nice.org.uk/guidance/ng158/chapter/Recommendations
App of the week:
MDCalc is one of the most crucial apps to have on your phone as a student / Doctor. It has all the scoring systems and it is very easy to use. So you could use it to calculate Wells PE score etc. Check it out
Song of the week:
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My name is Habib and I am a 5th-year Medical student currently in Cyprus. I grew up in Tanzania (Hakuna Matata is from the local language of my country and the second tallest mountain (Kilimanjaro) is found there).
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