Rejected at 6:20 p.m. May, 28, 2024 ] by Cameron
Author: cpochat
Related Note: 1495884130198 1
Rationale for change

This flow chart is incorrect/misleading in multiple locations.

First, following where there is contraindication to anticoagulation, a positive D-Dimer never confirms a PE. D-Dimer can only be used to rule out PE.

Second, I don't understand why a contraindication to anticoagulation would preclude risk stratification. Also, this arm directly differs from the flow chart below it.

Third, a positive CTA-PE or VQ scanconfirm a PE. There is no need to perform a D-dimer test after it has been done.

Fourth, following a hemodynamically unstable patient all the way down, it also leads to no CTA-PE or VQ scan. It again has only a positive D-Dimer confirming PE.

Fifth, emperic anticoagulation can, and should in the case of a high PTP, be started prior to obtaining a definitive diagnosis.

I would suggest immidately removing this from all notes and completely re-making it if necessary.
Source: AMBOSS - https://next.amboss.com/us/article/oh00Uf

Rejection reason

Thank you! Working on this now

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