Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of recurrent pulmonary embolism despite therapeutic anticoagulation. Current symptoms include [dyspnea/pleuritic chest pain/hemoptysis/syncope]. Patient reports strict adherence to [anticoagulant name/dosage]. Review of systems negative for recent trauma, surgery, or immobilization. No signs of active bleeding or recent medication non-compliance.
Clinical Examination Findings
Vitals: [HR, BP, SpO2 on RA]. General: Patient appears [distressed/comfortable]. CV: Tachycardia present, S1/S2 normal, no murmurs, JVD noted/absent. Resp: Tachypnea, clear to auscultation bilaterally or [crackles/wheezes]. Extremities: Assessment for DVT (unilateral swelling, tenderness, Homanโs sign). Skin: No petechiae or ecchymosis.
Treatment Protocol
Immediate management: 1. Stabilize hemodynamics. 2. Urgent CT Pulmonary Angiogram (CTPA) to confirm recurrence. 3. Assess anticoagulation compliance and therapeutic levels (e.g., anti-Xa levels for LMWH). 4. Consider transition to alternative agent (e.g., LMWH if on DOAC) or IVC filter placement if contraindications to anticoagulation exist. 5. Evaluate for underlying malignancy or hypercoagulable state.