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what is the step wise diagnosis of pulmonary embolism
1.x ray and gas exchange
2.v/q scan-best initial
3.doppler usg or compression usg -to rule out the source
i4.f all this are non diagnostic then pulm. angiography-gold standard
5.spiral ct - when?
please correct me and add your opinion.
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first start with history and s/s, these pt has classic "Hypoxia and HYPO-carbia", also tachycardia and tachypnea.
then you suspect PE clinically
you do CXR=you dont get anything
You may do EKG, you may not find anything, you may find RBBB
you do blood gas: hypoxia and hypocarbia
do V/Q scan
doppler to find out the source
Pulmonary angiogram, gold standard, but yo never do that !
Dont know when you do spiral ct
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Look Good to me
Spiral CT I don;t think is used rite now b/c of unknown efficacy compared to V/Q scan
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thankx triple helix,
uw says spiral ct is done when there is emboli in proximal pulm artery and if baseline xxray is abnormal. but i don't understand how to find out if emboli is in proximal pulm artery.
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The gold standard for the diagnosis of PE has long been the pulmonary angiogram. However, its use in critically ill patients is limited by invasiveness, expense, need for dye infusion, and the risks attendant to transport out of the ICU. In many patients, the pulmonary angiogram can be replaced by its noninvasive cousin, the helical computed tomography (CT) angiogram. Helical CT angiography is rapidly replacing both the ventilation-perfusion (/) lung scan and pulmonary angiography in the diagnosis of PE. The limitations of pulmonary angiography and / scanning, combined with residual doubts regarding the reliability of helical CT angiography, have led to attempts to supplant or augment these tests with alternatives. These include noninvasive leg studies, MRI imaging of the thorax, and various blood tests such as the D-dimer assay
From"Principles of critical care", chapter 27
