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Pulmonary Embolism-Myths and Misconceptions
Just wanted to mention a few myths/misconceptions about acute PE that I have recently heard discussed in the ED.
1. Emergency physicians have to "get help" to give thrombolytic therapy. Sure it makes sense that we consult critical care and perhaps interventional radiology in some cases. But we do not need permission to use this drug by ourselves if indicated. Consider using lytics ESPECIALLY if the patient is unstable or if there is evidence of RV dysfunction (elevated troponin, echo criteria for dysfunction, or CT with large RV and bowing of the septum). What about the patient with RV dysfunction and a normal BP? Evidence is mounting that lytics are indicated to reduce the severity of pulmonary hypertension.
2. "Just get a d-dimer." Be very careful. Lots of false positives. D-dimer often clouds the picture more often than not.
3. "The mortality rate of missed PE is high." Often quoted as a 30%+ mortality rate if missed. Recent data suggests that it is < 5%.