Pediatric emergency medicine trisk 2799 2799

intrapulmonary shunting, which may contribute to the hypoxemia seen in greater
than 80% of cases. Pleuritic chest pain and hemoptysis are often due to
pulmonary infarction related to the embolus.
Although a number of diagnostic modalities exist, the most common in
pediatrics is CT angiography. Validated clinical decision rules exist for use in
adult populations (e.g., Wells Criteria, Geneva Score, and Pulmonary Embolism
Rule-out Criteria [PERC]) although these scoring systems should be used with
caution in pediatric patient populations. Therefore, the challenge lies in
appropriately identifying those children who require further evaluation with CT,
with its increased risk from ionizing radiation exposure weighted against the risk
of missing this potentially serious diagnosis.

Goals of Treatment
PE is a rare, but potentially life-threatening condition in pediatrics which often
presents with nonspecific signs and symptoms. It can often be clinically
challenging to determine a patient’s risk of PE and need for advanced workup.
Once PE is diagnosed, the treatment goals are to correct hemodynamic or
respiratory abnormalities and to prevent progression of disease and recurrence.

Clinical Considerations
Clinical Recognition
Children with PE commonly have underlying medical conditions which
predispose them to thromboembolic events. CVCs have been identified as the
most common, while others include active malignancy, inherited thrombophilia,
nephrotic syndrome, inflammatory bowel disease, congenital heart disease,
collagen vascular diseases including systemic lupus erythematosus (SLE),
significant trauma/surgery, and severe infection/sepsis. Traditional “adult” risk
factors including oral contraceptives, elective abortion, prolonged
immobilization, IV drug use, rheumatic heart disease, smoking, and obesity may
also play a role in some older pediatric patients.
Triage

PE should be considered in the differential diagnosis for children with acute onset
pleuritic chest pain, particularly those with known risk factors for thrombosis.
Children presenting with significant respiratory distress require prompt
evaluation. Acute circulatory collapse from massive PE is rare in children, though
when present, it requires immediate resuscitative interventions.
Initial Assessment/H&P