Adult Medical Emergency Handbook - Scottish Intensive Care Society

THROMBOEMBOLIC DISEASE
DVT and pulmonary embolism are a spectrum of the same disease
and often co-exist. There are about 20,000 deaths per year from
thromboembolic disease in the UK. The clinical diagnosis is difficult. It
is therefore helpful to follow a process to assess clinical probability and
have an agreed investigative pathway which includes:
Recognition of the symptom complex
• Breathlessness
• Pleuritic chest pain
• Cough
• Haemoptysis
• Syncope (usually indicates major PE).
• The symptoms in isolation are not diagnostic and merely help
support the diagnosis or differential diagnosis.
Determination of the risk factors for thrombosis (risk increases
with age)
Major (5-20) Minor (2-4)
Surgery Cardiovascular disease
Pregnancy Oral contraceptive pill
Orthopaedic Hormone replacement therapy
Malignancy Obesity
Immobility, e.g. hospital Travel (>5-6hrs)
Previous VTE
FH of VTE
Baseline investigations
All patients with suspected pulmonary embolism should have standard
bloods, chest X-ray, ECG and arterial blood gases on admission.
The clinical probability of PE can then be determined:
High probability patients (>80% likelihood of PE)
• Risk factor present.
• Unexplained dyspnoea, tachypnoea or pleurisy.
• Unexplained radiographic changes or gas exchange abnormality.
Low probability (