PULMONARY-EMBOLISM .2. DIAGNOSIS AND TREATMENT

Pulmonary embolism is an often underestimated, underdiagnosed, and und ertreated disease. As symptoms and signs of pulmonary embolism are non specific, the diagnosis still remains a challenge to the attending phy sician. Diagnostic and therapeutic procedures depend on the clinical p resentation of the patient. First we must suspect pulmonary embolism a nd consider its likelihood in the presence of a number of clinical sig ns 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 n oninvasive diagnostic options should be considered to confirm or rule out the diagnosis of venous thromboembolism before further administrat ion of anticoagulant or thrombolytic agents. If the patient's status h as deteriorated, bedside diagnostic techniques should be applied to re inforce 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, w ith recent interest in short-term thrombolysis and bolus lysis with ur okinase or recombinant tissue plasminogen activator. If thrombolysis f ails or is contraindicated, catheter embolectomy or surgical embolecto my is indicated. The main therapy is prevention. In this article, clin ical 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 de scribed.