Abstract
Pulmonary embolism is an often underestimated, underdiagnosed, and undertreated disease.
As symptoms and signs of pulmonary embolism are nonspecific, the diagnosis still remains
a challenge to the attending physician. Diagnostic and therapeutic procedures depend
on the clinical presentation of the patient. First we must suspect pulmonary embolism
and consider its likelihood in the presence of a number of clinical signs and symptoms.
Once pulmonary embolism is suspected, heparin should be administered. Additional basic
support is mandatory if required. If the patient's hemodynamic situation is stable,
available preferable noninvasive diagnostic options should be considered to confirm
or rule out the diagnosis of venous thromboembolism before further administration
of anticoagulant or thrombolytic agents. If the patient's status has deteriorated,
bedside diagnostic techniques should be applied to reinforce the suspicion or establish
the diagnosis. To restore pulmonary perfusion more rapidly than conventional anticoagulation
is suspected to do, several dosing regimens of thrombolytic agents are proposed, with
recent interest in short-term thrombolysis and bolus lysis with urokinase or recombinant
tissue plasminogen activator. If thrombolysis fails or is contraindicated, catheter
embolectomy or surgical embolectomy is indicated. The main therapy is prevention.
In this article, clinical assessment, imaging techniques, and therapeutic options
described in the published literature are discussed and clinical experiences of an
emergency department with a noninvasive diagnostic approach are described.
Keywords:
Pulmonary embolism - heparin - rt-PA - thrombolysis - embolectomy
