Pulmonary Embolism and Massive DVT for Emergency Critical Care

Venous thromboembolism (VTE) as a first event occurs in 100 per 100,000 persons each year in the United States with an incidence that rises exponentially with age (White RH, Circulation 107:14–8, 2003). More than 60% of symptomatic VTE cases manifest as deep vein thrombosis (DVT) alone, whereas one-third of patients present with pulmonary embolism (PE) (White RH, Circulation 107:14–8, 2003). Recurrence occurs in approximately 7% of patients and happens more frequently with PE than DVT (White RH, Circulation 107:14–8, 2003; Cushman et al., Am J Med 117:19–25, 2004). The incidence of death within 30 days of diagnosis occurs in 6% of patients with DVT and 12% with PE (White RH, Circulation 107:14–8, 2003). Less common manifestations of venous thrombosis include phlegmasia alba dolens, phlegmasia cerulea dolens (PCD), and venous gangrene, which form a clinical spectrum that carries significant morbidity (Sarwar S, Narra S, Munir A, Tex Heart Inst J 36:76, 2009; Haimovici H, J Cardiovasc Surg 5:164–73, 1965). It is important for the emergency practitioner (EP) to appropriately recognize and treat VTE, as delays in diagnosis and treatment may result in a significant increase in morbidity and mortality.