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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

My Heart is Racing! Select Cardiac Arrhythmias and Practice Updates

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Contenido:

jueves, 24 de julio de 2014

PESI

UW Health - Nikki Pernot - 22/12/2012
"Introduction 
This guideline contains strategies and recommendations designed to assist clinicians in delivering and supporting effective outpatient treatment for pulmonary embolism. 
Practice Recommendations 
Eligibility Criteria for Outpatient Pulmonary Embolism management: 
• ≥ 18 years of age 
• Diagnosis of acute pulmonary embolism 
• Able and willing to comply with home care 
• Able to obtain necessary medications 
  If patient meets the eligibility criteria, calculate the PESI score based on table included 
 in the guideline. If PESI score is ≥ 86, hospitalize the patient. If PESI score is ≤ 85, 
 continue to the exclusion criteria: 
 Exclusion Criteria: 
• Intracardiac or central vein thrombus 
• Central PE (main pulmonary artery) 
• Requires admission for reasons other than acute PE/DVT 
• Not appropriate for long term anticoagulation (fall risk, unreliable, or unable to comply 
with follow up) 
• Any stroke in the last 6 weeks 
• Brain, spinal, or ophthy surgery in the last 6 weeks 
• Non-cutaneous surgery in the last 2 weeks 
• GI bleed in the last 2 weeks 
• Active major bleeding 
• History of HIT or heparin “allergy” 
• Theraputic anticoagulation at the time of diagnosis (e.g. INR ≥ 2) 
• Thrombocytopenia (< 75,000) 
• Other coagulopathy 
• Creatinine clearance , 30 mL/min 
• Hypoxia (< 90% at any time in the ED) 
• Hypotension (SBP , 100mmHg at any time in the ED) 
• RV strain on echocardiogram (if obtained) 
• Treated with thrombolytics in the ED 
• Pregnant 
• > 150 kg 
• BMI < 18
If no to all exclusion criteria, then the patient may be discharged with proper Home care instructions"
http://www.uwhealth.org/files/uwhealth/docs/anticoagulation/Pulmonary_Embolism_Management_in_the_Emergency_Department_Guideline.pdf