CME Adventure Update: From Paella to Pulmonary Embolism

Hello from Tenerife, Canary Islands!  My CME adventure has so far been magical. From chowing down on Paella at seaside European cafes and wandering the streets of Portugal to medical conferences in the cruise ship conference room, this CME conference pick is proving to be a good one.Although I am enjoying an island sightseeing experience, let me focus on what brought me here to the Canary Islands- medical education.  The lectures presented thus far in my conference have provided challenging and educational material.  I have discovered the latest treatment recommendations for acute coronary syndrome and identified emergent complications of cancer.  Tomorrow, I will uncover the secrets of opthalmologic, dermatologic and ENT emergencies.  My favorite lecture so far covered the topic of pulmonary embolism (PE).

I frequently use the PERC criteria as well as the Wells' criteria to rule out a diagnosis of PE in my low-risk patients.  For patients in whom I have a higher suspicion of PE, I order a D-Dimer to rule-out the possibility of PE.  Individuals with multiple risk factors or a high suspicion of pulmonary embolism get a V/Q or CT scan.  It can be difficult to differentiate between these risk stratifications.  I had never heard of the Charlotte Criteria to address this problem until yesterday's lecture.  This easy to use algorithm is about to become an integral part of my practice.

As most of you nurse practitioners know, if you are concerned about a diagnosis of pulmonary embolism in your patients, you can rule-out a PE in qualifying individuals using the D-Dimer lab test.  This test is extremely helpful as it excludes a potentially lethal diagnosis with simple blood work.  But what characteristics preclude a patient from falling into the group where a D-Dimer accurately eliminates PE from your list of differential diagnoses?  The Charlotte Criteria provides you the answer to this all-important question.  Taking into account a patient's age, risk factors and symptoms, this algorithm tells you when the D-Dimer test can adequately rule-out a PE diagnosis and when more invasive imaging is necessary.

I recommend becoming familiar with the guidelines and algorithms surrounding diagnosis of pulmonary embolism as they are extremely helpful.  I plan to incorporate them further into my practice and I hope you will too!

See you next in Lanzarote, Canary Islands where I will be volcano exploring, camel riding and furthering my medical education.