Date:
Patient:
Reason for Visit:
Confirmed or suspected pulmonary embolism (PE)
Evaluation of symptoms (e.g., shortness of breath, chest pain, hemoptysis)
Assessment of hemodynamic stability and right heart function
Management plan discussion
History:
Present Illness:
Onset, duration, and severity of symptoms suggestive of PE:
Shortness of breath (sudden onset, at rest or with exertion)
Pleuritic chest pain (sharp, stabbing pain, worse with inspiration)
Hemoptysis (coughing up blood) – less common
Cough (may be dry or productive)
Syncope (fainting) – in severe cases
Anxiety, sweating, palpitations
Risk factors for PE (consider Wells score or Geneva score for PE probability)
Recent surgery or immobilization
Prior history of DVT (deep vein thrombosis) or PE
Active cancer
Chronic medical conditions (heart failure, COPD)
Oral contraceptive use or hormone replacement therapy
Pregnancy or postpartum period
Obesity
Inflammatory bowel disease
Past Medical History (PMH):
Underlying medical conditions that may increase risk for PE
Previous surgeries or hospitalizations
Social History:
Smoking history
Recent travel (long distance flights)
Use of illicit drugs
Physical Exam:
Vital Signs: Assess for tachypnea (rapid breathing), tachycardia (fast heart rate), hypoxia (low oxygen levels), hypotension (low blood pressure).
General: Look for signs of respiratory distress (use of accessory muscles, cyanosis).
Pulmonary:
Auscultate for breath sounds (presence of crackles, wheezing).
Assess for jugular venous distention (JVD) – suggestive of right heart dysfunction.
Diagnostic Tests:
D-dimer test: A blood test to assess for the presence of blood clot breakdown products (elevated levels suggestive of a clot, but not diagnostic for PE).
Chest X-ray: May show nonspecific findings like pleural effusion (fluid around the lungs) or atelectasis (collapsed lung).
Electrocardiogram (ECG): May show signs of right heart strain.
Ventilation/perfusion (V/Q) scan or CT angiogram: Imaging tests to diagnose PE. V/Q scan compares ventilation (airflow) to perfusion (blood flow) in the lungs. CT angiogram provides a detailed image of the pulmonary arteries to identify blood clots.
Assessment:
Clinical suspicion for PE: Based on symptoms and physical exam findings.
Diagnostic confirmation of PE: Requires imaging tests like V/Q scan or CT angiogram.
Severity of PE: Hemodynamic stability, right heart function, and extent of lung involvement.
Risk factors for PE: Identify modifiable and non-modifiable risk factors.
Plan:
Thrombolysis (clot-busting medications): For high-risk PE with hemodynamic instability.
Anticoagulation therapy: Blood thinners like heparin followed by warfarin or novel oral anticoagulants (NOACs) to prevent further clot formation and propagation.
Consider duration of anticoagulation based on severity and risk factors.
Supportive care: Oxygen therapy for hypoxemia, pain management, and monitoring for complications.
Inferior vena cava (IVC) filter placement (may be considered): A small device placed in a large vein to prevent blood clots from traveling to the lungs (for high-risk patients or those with contraindications to anticoagulation).
Referral to a pulmonologist or cardiologist: For complex cases or hemodynamic instability.
Patient education: Provide information about PE, risk factors, importance of medication adherence, signs and symptoms to watch for, and fall prevention strategies.
Follow-up:
Schedule for regular follow-up appointments to monitor symptoms, assess response to treatment, and adjust medications as needed.
Discuss long-term management plan to prevent recurrent PE.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of pulmonary embolism.