SevernSide Pathway for Suspected Pulmonary Embolism in Adults

So, when you are on shift, and you are consulting with a patient who you suspect may have a PE, please have a look at the flow chart below.

Please note that the Community Pathway is only appropriate for clinically stable, low risk patients.  You will continue to consider immediate hospital assessment for all patients with suspected PE who are haemodynamically unstable, pregnant, under 6 weeks post partum,  already on anticoagulation or where an alternative serious diagnosis needs to be rules out (eg. ACS, pneumothorax, etc).

The pathway above is also available on Remedy: remedy pathway (bnssgccg.nhs.uk)

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NOTES ABOUT D.DIMER

The pathway requires a Laboratory D.dimer (not Point of Care Test)

D.dimer can be tested as long as it reaches the lab within 24hours (stored at 18-25oC or 2 – 6oC)

Remind clinicians to ensure blue tube is completely full (otherwise the same will be rejected)

If GP’s pathology transport has already gone, patients can take their own samples to the hospital (drop at ED reception) as long as fully bagged and labelled.

 

?PE in pregnancy

NBT

Under 21 weeks patients should go to medics as usual (SDEC if stable, AMU if unstable).

From 21 weeks onwards AND Post partum patients (up to 6 weeks post partum)  suspected PE goes to the O&G team. The exception here being a clinically unstable patient. Contact the Obstetrics Registrar to discuss, if the patient is unstable consideration will be made to admit under medicine.

• Obs Reg – Bleep 9360 via NBT Switch (0117 4143999)
• Obs SHO – Bleep 9342 via NBT Switch (0117 4143999)

BRI

Under 24 weeks – medicine (SDEC ideally)

Over 24 weeks – there is currently no consensus at UHBW about where these women should be assessed. If the patient is clinically stable, please discuss with the Acute Physician in the first instance (01173426860). If the patient is clinically unstable (eg. significant tachycardia/hypotension), consider ED (call ahead to ED, number in telephone directory).

WGH 

Weston cannot admit patients who are beyond 19 + 0 weeks of pregnancy, so if there is a high likelihood of a patient who is pregnant requiring a medical admission it is best to direct elsewhere. If admission deemed unlikely and simply a work up required, then WGH medical team can accept ? suspected PE in pregnant patients.

Suspected Chronic PE

Sometimes the WDPL gets calls about patients with longstanding (several weeks/months) of SOB and the referrer is querying chronic PE. There is no specific pathway for these patients. Consider seeking case by case advice from Acute Medicine or Respiratory.

Please note that a D.dimer is not validated in chronic PE and the patient should not go down the Community Pathway for Suspected Acute PE (above).

If the patient is in any way unstable (eg. tachycardic, low sats, drop in exertional sats) – then consider urgent assessment via AEC/SDEC/Acute Medicine Clinic or Resp Hot Clinic

If the patient is very stable – consider asking the referrer to request an urgent outpatient CTPA and urgent outpatient respiratory appointment (not hot clinic). NB. Urgent outpatient CTPA can take several weeks. The referrer can speak to radiology secretary of the day at NBT to highlight the urgency. 0117 414 9110