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Pulmonary Embolus (suspected)

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Checked: 23-04-2022 by Rob Adams Next Review: 23-04-2023

When to suspect PE

Clinical Knowledge Summaries gives some advice on When to Suspect PE.

Managing suspected PE

BNSSG has a new pathway for investigating suspected acute pulmonary embolism in adults:

BNSSG Community Pathway for Investigating Suspected Acute Pulmonary Embolism in Adults.

Please see the above link for a local adaptation of the NICE guidance
This has been developed by BrisDoc clinicians and is under further evaluation, to ensure we achieve the outcomes we want for our population, deliver a quality service, and that resource is allocated accordingly
There is a steering group looking at this pathway and the implications; this has BrisDoc, CCG, LMC, urgent care and acute care colleagues as members
If you have any concerns about following the pathway, or wish to discuss your patient further, please call the Weekday IUC Professional Line: 01172449283 for a clinician to clinician conversation
We will update this page as the evaluation progresses

Please note that this pathway requires a laboratory D.dimer (not a point of care test).

Further information can be found on Clinical Knowledge Summaries: Managing Suspected PE.

Red Flags

Arrange immediate admission for people with suspected pulmonary embolism:

If they are severely ill with any of the following features:

Altered level of consciousness.
Systolic BP of less than 90 mmHg.
Heart rate of more than 130 beats per minute.
Respiratory rate of more than 25 breaths per minute.
Oxygen saturation of less than 91%.
Temperature of less than 35°C.

If they are pregnant, or have given birth within the past 6 weeks.

For all other people, use the two-level PE Wells score to estimate the clinical probability of PE Managing Suspected PE and follow the BNSSG pathway above.

Referral

If the two-level PE Wells score advises referral for a CTPA please contact the IUC professional line: 0117 2449283.

If the IUC line is closed then please arrange a medical admission.

Interim anti-coagulation

Clinical Knowledge Summaries suggests the following:

If interim therapeutic anticoagulation is required:

Offer apixaban or rivaroxaban first line, and if these are not suitable, low molecular weight heparin (LMWH) for at least 5 days followed by dabigatran or edoxaban, or LMWH concurrently with a vitamin K antagonists for at least 5 days.
Take into account comorbidities, contraindications and the person's preferences when choosing anticoagulation treatment.

For people starting interim anticoagulation therapy:

Carry out baseline blood tests including full blood count, renal and hepatic function, prothrombin time (PT) and activated partial thromboplastin time (APTT).
Do not wait for the results of baseline blood tests before starting anticoagulation treatment.
Review, and if necessary act on, the results of baseline blood tests within 24 hours of starting interim therapeutic anticoagulation.

For more information on prescribing anticoagulants, see the sections on Parenteral anticoagulants and Oral anticoagulants.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.