A 1-2-3 APPROACH TO DIAGNOSE PULMONARY EMBOLISM

Too many Americans die (unnecessarily) as the result of undiagnosed pulmonary embolisms. In a recent online seminar on Medscape, three doctors discussed the procedure for diagnosing pulmonary embolisms http://en.wikipedia.org/wiki/Pulmonary_Embolism.

Three doctors participated:
– Dr. Sam Goldhaber, Professor of Medicine at Harvard Medical School and Director of the Venous Thromboembolism Research Group at Brigham and Women’s Hospital
– Dr. Art Sasahara, Professor Emeritus and Senior Physician at Brigham and Women’s Hospital in Harvard Medical School
– Dr. Greg Piazza, Fellow in Cardiovascular Disease at Beth Israel Deaconess Medical Center

Diagnosing the presence of a pulmonary embolism is a crucial diagnosis for internal medicine physicians and something all doctors learn in medical school. The problem is that mistakes and failures continue to occur.

The procedure proposed by the panel includes:
1. Using a clinical decision scoring system during the history and physical portion of the examination. Physicians can decide if their patient is pulmonary embolism-unlikely or pulmonary embolism-likely;
2. If the patient has a high score, they go immediately for a CT chest scan. If the patient has a medium or low score, the physician orders a D-dimer test; and
3. If the patient has a high clinical decision score or an elevated D-dimer test score, the physician orders a CT scan

Once a pulmonary embolism is diagnosed it can be treated. The present problem is the physician’s failure to identify the symptoms and a failure to acknowledge that the presence of a pulmonary embolism is a possibility. Doctors need to become proactive in diagnosing pulmonary embolism rather than waiting for the patient to become hypotensive.

Dr. Piazza also presented an abstract at the American College of Cardiology (ACC) entitled “Double Trouble in Medical Patients” which shows that hospitalized medical patients receive venous thromboembolism prophylaxis only a quarter of the time and they suffer pulmonary embolism more often than non-medical patients.

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