and easy to obtain in most EDs, very accurate Advanced Imagining for PE in Pregnancy CTA and reveals other possible diagnoses that could cause PROS- in pregnancy, even one abdominal CT is chest pain/shortness of breath Limitations- patients with renal failure, patient below known threshold of harm for radiation for the fetus so radiation should not be a concern, can adjust exceeds the weight limit of the CT table, pregnancy CT scanner settings to avoid scanning into the (relative limitation- see below) abdomen V/Q scan - IV radioactive tracer is injected to examine CONS- concern over radiation exposure, more pulmonary vasculature followed by inhaling a radioactive tracer, if a lung segment ventilates but does not perfuse, it CT scans in pregnancy due to physiologic suggests a PE changes (changes in blood volumes and cardiac Limitations- much less accurate than CT, does not output), ? harms of contrast exposure in pregnancy for fetus (not proven in literature but likely never to reveal alternate diagnoses, Chest x-ray needs to be get a good answer on this) completely clear for it to be useful V/Q scan Only useful if the test is read as completely PROS- if chest x-ray is normal then higher rate of negative/normal diagnostic scans compared to CT, much less radiation a probability” of PE still has a risk of PE “low exposure of 20% (way too high) CONS- not as accurate as CT, radioactive tracer Bilateral lower extremity ultrasounds- in a patient with signs and/or symptoms suggestive of PE, a clot in the legs concentrates in the bladder which is right next to the pretty much equals a clot in the lungs- however, if negative uterus (can have patient urinate immediately after it’s not helpful at all- can be used in pregnancy as an option scan to reduce radiation exposure) but usually prefer better confirmation in form of CT or V/Q PEARL- follow your institution’s guidelines in regards to choice of scan test and consenting patients for PE imaging in pregnancy. Go through the pros and cons of whatever imaging you choose and have the patient sign a consent form after a frank discussion of all the risks and benefits PEARL- PE is a serious disease in pregnancy- you can’t not pursue the diagnosis because the workup may be difficult 33 Pulmonary Embolism II - Risk Stratification & Treatment Risk stratification of PE
and easy to obtain in most EDs, very accurate and reveals other possible diagnoses that could cause chest pain/shortness of breath Limitations- patients with renal failure, patient exceeds the weight limit of the CT table, pregnancy (relative limitation- see below) V/Q scan - IV radioactive tracer is injected to examine pulmonary vasculature followed by inhaling a radioactive tracer, if a lung segment ventilates but does not perfuse, it suggests a PE Limitations- much less accurate than CT, does not reveal alternate diagnoses, Chest x-ray needs to be completely clear for it to be useful Only useful if the test is read as completely negative/normal a “low probability” of PE still has a risk of PE of 20% (way too high) Bilateral lower extremity ultrasounds- in a patient with signs and/or symptoms suggestive of PE, a clot in the legs pretty much equals a clot in the lungs- however, if negative it’s not helpful at all- can be used in pregnancy as an option but usually prefer better confirmation in form of CT or V/Q scan Advanced Imagining for PE in Pregnancy CTA PROS- in pregnancy, even one abdominal CT is below known threshold of harm for radiation for the fetus so radiation should not be a concern, can adjust CT scanner settings to avoid scanning into the abdomen CONS- concern over radiation exposure, more CT scans in pregnancy due to physiologic changes (changes in blood volumes and cardiac output), ? harms of contrast exposure in pregnancy for fetus (not proven in literature but likely never to get a good answer on this) V/Q scan PROS- if chest x-ray is normal then higher rate of diagnostic scans compared to CT, much less radiation exposure CONS- not as accurate as CT, radioactive tracer concentrates in the bladder which is right next to the uterus (can have patient urinate immediately after scan to reduce radiation exposure) PEARL- follow your institution’s guidelines in regards to choice of test and consenting patients for PE imaging in pregnancy. Go through the pros and cons of whatever imaging you choose and have the patient sign a consent form after a frank discussion of all the risks and benefits PEARL- PE is a serious disease in pregnancy- you can’t not pursue the diagnosis because the workup may be difficult 33 Pulmonary Embolism II - Risk Stratification & Treatment Risk stratification of PE
EM_Basic_-_Pocket_Guide.docx