Corrigan Daniel, Prucnal Christiana, Kabrhel Christopher
Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Clin Exp Emerg Med. 2016 Sep 30;3(3):117-125. doi: 10.15441/ceem.16.146. eCollection 2016 Sep.
The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis. In recent years, several advances in treatment have also emerged. Novel, direct-acting oral anticoagulants make the outpatient treatment of low risk PE easier than before. However, the spectrum of PE severity varies widely, so emergency physicians must be able to risk-stratify patients to ensure the appropriate disposition. Finally, PE response teams have been developed to facilitate rapid access to advanced therapies (e.g., catheter directed thrombolysis) for patients with high-risk PE. This review will discuss the clinical challenges of PE diagnosis, risk stratification and treatment that emergency physicians face every day.
对于急诊医生而言，诊断或排除肺栓塞（PE）仍然具有挑战性。症状可能模糊不清或不存在，临床表现与许多其他常见诊断有共同特征。诊断测试很复杂，因为生物标志物（如D - 二聚体）经常出现假阳性，而影像学检查（如计算机断层扫描肺动脉造影）存在辐射和造影剂暴露风险。因此，急诊医生有责任对这一诊断保持警惕并深思熟虑。近年来，治疗方面也出现了一些进展。新型直接口服抗凝剂使低风险PE的门诊治疗比以前更容易。然而，PE严重程度范围差异很大，所以急诊医生必须能够对患者进行风险分层，以确保合适的处置。最后，已经组建了PE反应小组，以便为高危PE患者快速提供先进治疗（如导管定向溶栓）。本综述将讨论急诊医生每天面临的PE诊断、风险分层和治疗的临床挑战。
