RESPIRATORY

Take a focused history from a patient with a suspected pulmonary embolism, to include past medical history, drug history, family history and social history. Perform a focused respiratory examination on the patient if appropriate.

Document your findings in a systematic manner. You may want to use a local clerking proforma or have a look at this useful summary from Geeky Medics.

Write down 3-5 key differential diagnoses, with the most likely at the top. From this list, suggest one or two key features from the history and/or examination that makes each more and less likely.

Find a drug chart and prescribe the appropriate treatment dose LMWH. Use a BNF if needed. You might need to find out the patient's weight.

Find the local guidelines on thrombolysis on the trust intranet. Consider when might it be appropriate to thrombolyse a patient with a pulmonary embolism? Suggest three circumstances.

Find the local guidelines on outpatient management of patients with newly diagnosed PE. Alternatively, use the BTS Pulmonary Embolism 2019 guidelines.

Consider:

• Can a patient with a PE be managed as an outpatient?

• What provision for follow-up does this hospital provide? e.g. a thrombosis clinic or ambulatory emergency care centre

• What is the role of ECHO in acute pulmonary embolism?

• Should all patients with unprovoked DVT be screened for malignancy?

You may find it helpful to speak to a thrombosis nurse or one of the junior doctors on the ward to clarify the answers to these questions.

1. https://radiopaedia.org/

2. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz405/5556136

3. https://geekymedics.com/clerking-101/

4. https://www.brit-thoracic.org.uk/document-library/guidelines/ambulatory-pe/bts-guideline-for-the-initial-outpatient-management-of-pulmonary-embolism/