Acute Pulmonary Embolism Clinical Pathway – Emergency Department, ICU and Inpatient

History and Physical

Symptoms of PE in children can be non-specific and mimic the symptoms of the underlying disease.
Always consider PE as part of the differential diagnosis of children who are critically ill.
Note: Diagnostic tools such as the Well’s Criteria, PERC are not validated in pediatric patients.

History	HPI Cough, shortness of breath, cyanosis Hemoptysis Chest pain, palpitations Dizziness, syncope Leg swelling, pain Current or recent venous thromboembolism (VTE) Presence of central venous catheter (CVC) Review risk factors for PE
Physical Exam	VS Tachycardia, tachypnea, hypoxia Signs of impending, existing cardiorespiratory failure Signs of DVT, leg swelling

Risk Factors for PE

Acute Conditions	Active cancer Burns > 50% total body surface area Critically ill Currently in an intensive care unit or recently admitted in prior 30 days Major trauma within 30 days Pregnancy Severe dehydration Severe systemic infection within 30 days Spinal cord injury within 30 days Surgery within 30 days Decreased mobility within 30 days
Chronic Medical Conditions	Estrogen-containing medications within 30 days Inflammatory disorders IBD SLE Chronic extensive GVHD Known acquired or inherited thrombophilia Protein-losing disorders Nephrotic syndrome PLE Draining chylous effusion Sickle cell disease Obesity < 18 yrs: BMI > 95% > 18 yrs: BMI < 30
Historical Factors	History of blood clots History of VTE in 1^st degree relative < 40 yrs old

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Acute Pulmonary Embolism Clinical Pathway – Emergency Department, ICU and Inpatient

History and Physical

Risk Factors for PE

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Innovation and your child

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Acute Pulmonary Embolism Clinical Pathway – Emergency Department, ICU and Inpatient – History and Physical

Acute Pulmonary Embolism Clinical Pathway – Emergency Department, ICU and Inpatient

History and Physical

Risk Factors for PE