English

Abstract

Pulmonary embolism (PE) is frequent in our country and accounts for thousands of hospitalization with significant mortality and morbidity. Diagnosing PE in our country is very difficult where there is paucity of high resolution multi-detector 64 slice CT scan along with financial limitations of patients. We can diagnose moderate to large pulmonary embolism with the help of D Dimer assay, electrocardiography, echocardiograph, Chest X ray along with symptoms which are highly suggestive of pulmonary embolism apart from the gold standard that is high resolution 64 slice multi-detector CT scan. There is a greater need to confirm and diagnose PE with the help of D- dimer assay, electrocardiography, Echocardiograph, Chest X ray in patients who present with features of PE(wells criteria) in our country because either most hospital in our country do not have multi detector CT scan or patient is not financially sound to afford it. We can still diagnose PE without CT scan and thus in turn can treat most of the patients with moderate to large pulmonary embolism without high resolution CT scan. INTRODUCTION: Pulmonary embolism accounts for millions of hospitalizations annually worldwide. Although D-Dimer testing for exclusion of PE and chest computed tomography(CT)for imaging PE have revolutionized the diagnostic approach, PE remain difficult to detect unless high index of clinical suspicion is kept during management of critically ill patients. Our understanding of the precipitants of PE has improved especially the role of hyper- coagulable states and potentially modifiable risk factors such as long-haul air travel and obesity. Doctors in critical care and cardiologist must provide expertise in the treatment of hemodynamically compromised patients with PE as well as those with right ventricular failure who maintain a stable blood pressure and heart rate. This requires rapid and accurate risk stratification, often with echocardiography, elevation of troponin, D-dimer assay, brain natriuretic peptide levels, so that those patients with adverse prognosis will be identified and treated with thrombolysis or embolectomy.