SUSPECT DIAGNOSIS:-

 ·       Anybody with sudden onset of breathlessness

·       Hypoxia with clear chest X-ray

·       Sinus tachycardia on ECG and

·       Signs of right heart failure/strain on ECG (S1, Q3, T3)

PRESENTATIONS:

 70-90% present with

Sudden onset of breathlessness

 Pleuritic chest pain 70% Cough 40-50 %

Hemoplysis 20 %

Look for signs of tachycardia, tachypnoea and

 Loud P2, raised JVP Inspiratory crackles Pleural rub

Pleural effusion (80% hgic and 20% Transudative) DVT, Varicose veins

Look for stressors/predisposing factors to support diagnosis (their presence being, most specific)

 Immobilization/stroke Orthopedic surgery Pelvic/lower limb fractures

Obesity OCP/Pregnancy/Postpartum Indwelling central venous line

Occult carcinoma/chemotherapy for same

CONSIDER DIFFERENTIALS

 ·       MI/Unstable angina… ECG changes, history, description of pain

·       Pneumonia, COPD, pneumothorax                 X-ray chest

·       CCF…… Usually no chest pain, more chronic, insiduous onset

·       Asthma…… Improvement with bronchodilators

·       Pericarditis…           ECG, pain>dyspnoea

·       Primary pulmonary HT

·       Costochondritis…Tender costochondrial junction

·       Psychogenic hyperventilation.............. Inconsistent history and findings

Preliminary investigations:-

 Hb, TC/Dc, Platelets, ABG (PaO2 <80 mm of hg with decreased PaCO2 Baseline PT/PTT for starting anticoagulation Rx

Chest X ray ECG

ECHO

Primary therapy:-

 General … A-B-C, management of critically ill patients

·       Pain relief

·       Do not volume overload

·       Dobutamine for heart failure/cardiogenic shock

·       Parenteral anticoagulation

Start oral anticoagulation at the onset itself