Group 1 Presentation Pulmonary Embolism. Introduction to Pulmonary Embolism Typical Scenario Team Based Approach Nurse Physician History and Examination Barriers to Care Decision Support Tools General Overview Prediction Rules and Calculators EHRs and Applications Tests
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Taking vital signs
Providing Initial Assessments
Providing patient notes for clinicians
Implement physician orders
Nurse : Hello my name is ____, I will be your nurse today. Just in case you forget, I will write my name on the board as well as the hours I am here today. Mr.____, I see that you’re here because you’re not feeling well. Can you please explain to me what’s going on?
Nurse: I see, well I will certainly convey these details to Dr.___. Now Mr. ____, I need to take your pulse, blood pressure, and temperature, is that ok?
Patient’s response: Yes.
Nurse takes his blood pressure.
Nurse: I see that your blood pressure is a bit elevated. Do you normally have high blood pressure?
Note: For information only, no narrative included on this slide
Physician: Hello Ms. Benes, I’m Dr. Van Nostrand, why don’t we start with you telling me a little bit about what brought you in today.
Patient: Well, it started yesterday when I was gardening with my grandchildren. I stood up too quickly and became lightheaded. After that happened I went inside to rest for a bit and since then I have been finding it difficult to catch my breath. I really think it is nothing, but my daughter insisted that I come in to see you. I don’t see the point in wasting time when we have so much to do before I leave on Friday.
Physician: Yes, the nurse tells me you are here visiting and you flew in from Texas. So it sounds like you have shortness of breath and some lightheadedness. Is this correct? Is there anything else are you experiencing?
Patient: I suppose, I have had a little bit of a cough since I have arrived, but a lot of times the air here will bother me. I think it is all of the car exhaust.
Physician: What about any pain in one or both of your legs?
Patient: No, I don’t believe so.
Physician: I noticed you have been coughing a little bit. Is that new?
Patient: Yes, it started this morning.
Physician : When you cough is it productive? That is, does anything come out?
Patient : No, not really, it is just a tickle in my throat really.
Physician : Have you been traveling a lot recently, before this trip?
Patient : Yes, I just retired so I’m seeing all my grandchildren.
Physician : Do you happen to know if you have ever had a pulmonary embolism before?
Patient : I haven’t even heard of that before, so I don’t think so.
Physician : Have you had surgery recently?
Patient : No, I have not.
Physician : Okay, I understand. If it is alright with you, I’m going to preform my examination now.
CT Pulmonary Angiography Decision Support
d-Dimer level and clinical suspicion entry tools and decision support statements 1 and 2.
Raja A S et al. Radiology 2012;262:468-474
I-Phone QxMD PE Clinical Probability Calculator