Alkinj et al classified a pulmonary embolus by hemodynamic effects. These can help to identify a patient who requires more aggressive management. The authors are from the Mayo Clinic in Rochester.
Classification of pulmonary emboli:
(1) massive
(2) submassive
(3) low-risk
Clinical and hemodynamic parameters:
(1) need for intubation
(2) need for cardiopulmonary resuscitation (CPR)
(3) hypotension (systolic blood pressure less than 90 mm Hg for >= 15 minutes OR requiring intropic support)
(4) signs of right ventricular dilatation or dysfunction on echocardiography
(5) serum troponin concentration
Parameter
Massive PE
Submassive PE
Low Risk PE
intubation
variable
absent
absent
CPR
variable
absent
absent
hypotension
variable
absent
absent
right ventricular dysfunction
NA
variable
absent
elevated serum troponin
NA
variable
absent
where:
• For massive and submassive PE at least one variable finding must be present.
The diagnosis requires exclusion of other causes for the findings.
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