Pulmonary Embolism, Acute — History and Physical Exam — Clinical Pathway: Emergency Department, ICU and Inpatient

Acute Pulmonary Embolism Clinical Pathway — Emergency Department, ICU and Inpatient

History and Physical Exam

Symptoms of PE in children can be non-specific and mimic the symptoms of the underlying disease. Always consider PE as part of the differential diagnosis of children who are critically ill.

Note

Diagnostic tools such as the Well’s Criteria, PERC are not validated in pediatric patients.

History
  • HPI
    • Cough, shortness of breath, cyanosis
    • Hemoptysis
    • Chest pain, palpitations
    • Dizziness, syncope
    • Leg swelling, pain
    • Current or recent venous thromboembolism (VTE)
    • Estrogen containing medications
    • Review risk factors for PE
  • PMH
    • History of previous clots
    • Known clotting disorder
    • Presence of Central Venous Catheter (CVC)
  • Family History
    • History of VTE in 1st degree relative < 40 years old
Physical Exam
  • VS
  • Tachycardia, tachypnea, hypoxia
  • Signs of impending, existing cardiorespiratory failure
  • Signs of DVT, leg swelling

Risk Factors for Pulmonary Embolism

Acute Conditions
  • Active cancer
  • Burns
    • > 50% total body surface area
  • Critically ill
    • Currently in an intensive care unit or recently admitted in prior 30 days
  • Major trauma within 30 days
  • Pregnancy
  • Severe dehydration
  • Severe systemic infection within 30 days
  • Spinal cord injury within 30 days
  • Surgery within 30 days
  • Decreased mobility within 30 days
Chronic Medical Conditions
  • Estrogen containing medications within 30 days
  • Inflammatory disorders
    • IBD
    • SLE
    • Chronic extensive GVHD, etc.
  • Known acquired or inherited thrombophilia
  • Protein losing disorders
    • Nephrotic syndrome
    • PLE
    • Draining chylous effusion
  • Sickle cell disease