title: Diagnostic and therapeutic approach to acute pulmonary embolism in an emergency department.
abstract: Pulmonary embolism (PE) is the obstruction of the pulmonary arteries by the dislodging and embolization of thrombotic material coming in most cases from the deep veins of the leg. PE is a relatively common disease with an estimated annual incidence up to 37 cases diagnosed per 100,000 persons it is the third cause of death in the United States. Clinical signs and symptoms are non specific and in the 70% of cases there isn't a correct diagnosis. The aim of this review is to summarize the state of the art of the diagnostic and treatment algorithms of PE in the evidence based medicine in order to minimize the "clinician gestalt" by the only guide for the early diagnosis and treatment of the disease. A correct diagnosis based on pre test probability, the use of computed tomographic pulmonary angiography, early anticoagulation/fibrinolysis started in the Emergency Department can change the natural history of the disease. In perspective, a combined approach of localyzed fibrinolysis and mechanical fragmentation could improve the overall outcome of these patients.
authors.affiliation: Department of Emergency Medicine, Catholic University of Sacred Heart - Rome, Italy. pietro.tilli@tin.it
authors.forename: P
authors.initials: P
authors.lastname: Tilli
authors.forename: A
authors.initials: A
authors.lastname: Testa
authors.forename: M
authors.initials: M
authors.lastname: Covino
authors.forename: P
authors.initials: P
authors.lastname: Portale
authors.forename: L
authors.initials: L
authors.lastname: Capaldi
authors.forename: L
authors.initials: L
authors.lastname: Carbone
authors.forename: N Gentiloni
authors.initials: NG
authors.lastname: Silveri
mesh_terms: D000208:Acute Disease; D004452:Echocardiography; D004562:Electrocardiography; D004632:Emergency Medical Services; D006801:Humans; D015994:Incidence; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology