The key is "suspected" PE. In the several medical centers where I have
worked (as a Registered Respiratory Therapist as well as RVT, RDCS), I have
witnessed numerous VQ scans and Venous "Dopplers" on patients with normal
blood gases and normal SpO2s on room air. It seems that everytime someone
comes in complaining of SOB or has an anxiety attack, the first thought is
PE, regardless of objective data to the contrary. Patient's in ICU are the
worst. No acute change (decrease) in SpO2, PaO2, or SaO2 on consistent
FIO2, yet let's rule out PE before we look at anything else.
From: Don Ridgway [mailto:[log in to unmask]]
Sent: Thursday, February 01, 2001 11:20 AM
To: [log in to unmask]
Subject: Re: PE/DVT
I know that this is after your meeting, but the battle surely goes on. I
just read this recently in that Yearbook of Vascular Surgery 2000 (p. 456)
that I recommended here recently, from a study by van Rossum, et al., in
British Journal of Radiology:
Results of a series of 149 patients: DVT prevalence was 12% in patients with
suspected PE, and 32% in patients with proven PE. A meta-analysis of
literature yielded DVT in patients with proven PE ranging from 10% to 93%.
"For all reports, the pooled estimate of the prevalence of DVT among
patients with suspected PE was 18%."
Dr. Porter's comment: "I fail to see how either a positive or a negative
result from the vascular laboratory will or should alter patient treatment.
Certainly, a negative result most assuredly does not rule out PE, and a
positive result does not rule in PE. I believe that, in general, this is an
inappropriate use of the vascular laboratory."
Obviously, if there are leg symptoms or big risk factors (like cancer), I
assume it would make more sense to have us take a look.
> From: Amy Tisch
> Reply To: UVM Flownet
> Sent: Tuesday, January 30, 2001 8:19 AM
> To: [log in to unmask]
> Subject: PE/DVT
> Does anyone have any published articles on the incidence of DVT in
> patients with
> NO lower extremity symptoms who are being worked up for R/O PE? ...or
> gathered in you labs? THANK YOU! Please respond at your earliest
> convenience -
> we are gathering info for a meeting tomorrow at 3PM!!!Thanks, again!