I found a structured guideline, comprising a reference section, summary of PE Summary Chartrecommendations, and a practical  section for junior doctors about the management of suspected acute pulmonary embolism. This updated guidelines focused on suspected pulmonary embolism (PE) and only include deep vein thrombosis (DVT) where relevant, even though both are part of venous thromboembolism (VTE). PE is potentially more serious and has a differential diagnosis of other serious conditions; many hospitals have established local protocols for the diagnosis and treatment of DVT but not for suspected PE. Prophylaxis of VTE even this is a common in hospitalised patients, are beyond the scope of the guidelines.

There were predisposing factors for VTE being summarised in this guidelines. It described clinical, D-dimer, Imaging, Massive PE, and Treatment of PE. In the Clinical Features we can find all patients with possible PE should have clinical probability assessed and documented, and an alternative clinical explanation should always be considered at presentation and sought when PE is excluded.

D-dimer assays may have an important role in accurately excluding PE. It also stated that if D-dimer levels are normal following cessation of anticoagulation, recurrence of idiopathic VTE is very unlikely. There were kind of Imaging modalities recomemmendation to exclude PE such Isotope lung scanning, Leg ultrasound, Conventional pulmonary angiography, Computed tomographic pulmonary angiography (CTPA), Echocardiography, Transthoracic ultrasound, Magnetic resonance angiography, and Emergency imaging.

Supportive therapy includes oxygen, analgesia, plasma expanders and inotropic support are common practice medication to treat massive PE. Also stated that thrombolysis is the first line treatment for massive PE and may be instituted on clinical grounds alone if cardiac arrest is imminent; a 50 mg bolus of alteplase is recommended. But thrombolysis should not be used as first line treatment in non-massive PE, according to the guidelines.

Find this interesting article about Updated Guidelines Focused on Suspected Pulmonary Embolism including table, summary charts, and notes for junior doctors. Complete read provided in 15 pages of PDF filetype (source:thorax.bmj.com) or here if you meet trouble in downloading it. Browse also another Internal Medicine Journal.