When deciding on references, consider whether the journal is high impact. References should also be within the last 5 years.

· References should be more related to practice guidelines and not clinical trials. We want to make sure that the presentation is clear on how to diagnose and treat PE related to current standards of practice. See below some links that may help.

· https://pmc.ncbi.nlm.nih.gov/articles/PMC7284001/

· https://www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-practice-guidelines/venous-thromboembolism-guidelines/treatment

· https://www.ncbi.nlm.nih.gov/books/NBK560551/

· https://www.nejm.org/doi/full/10.1056/NEJMcp2116489

· Often times a hematologist will be consulted to see a patient with newly diagnosed DVT or PE. This would be a good source to reference from the American Society of Hematology.

· Add 2 slides to the outline:

· Comparison of prior standards for diagnosing and treating PEs. Remember our audience will be practitioners in practice with 20+ years and novice practitioners.

· Populations for Special Considerations for treating PEs

· What happens if a patient cannot be treated with Heparin, etc? The standard treatments.

· Are there special considerations for cancer patients, older adults, etc.

· Add treatment education for patients.

SOLUTION

Presentation Title: Pulmonary Embolism – Evidence-Based Diagnosis and Management

Slide 1: Title Slide

Title: Pulmonary Embolism: Updated Clinical Practice Guidelines
Your name, credentials
Institution
Date

Slide 2: Objectives

Describe current guideline-based methods for diagnosing and managing PE.
Compare prior vs. current standards of care.
Identify treatment adaptations for special populations.
Provide practical education strategies for patient management.

Slide 3: Overview of Pulmonary Embolism (PE)

Definition: Blockage of pulmonary artery by thrombus
Pathophysiology: Often from deep vein thrombosis (DVT)
Clinical urgency due to high mortality without prompt treatment

Slide 4: Epidemiology and Risk Factors

~1 per 1000 persons per year
Risk factors: Immobility, cancer, recent surgery, hormone therapy, obesity, history of DVT/PE

Slide 5: Clinical Presentation

Symptoms: Dyspnea, pleuritic chest pain, hemoptysis, syncope
Signs: Tachycardia, hypoxia, leg swelling (if DVT), elevated JVP

Slide 6: Diagnostic Tools – Current Guidelines

Risk stratification: Wells Score, Geneva Score
D-dimer for low/moderate-risk patients
Gold standard: CT Pulmonary Angiography (CTPA)
V/Q scan for renal insufficiency or pregnancy
Bedside echocardiography for unstable patients

Source: Konstantinides et al., 2020; ASH Guidelines, 2020
NEJM Clinical Practice Article, 2022

Slide 7: Comparison to Prior Standards

Before: Universal imaging and anticoagulation without scoring
Now: Risk-based decision-making, PERC rule, outpatient eligibility
Emphasis on avoiding unnecessary anticoagulation or radiation exposure

Source: Piazza & Goldhaber, 2022 (NEJM)
NIH Book: PE Diagnostic Approach

Slide 8: Initial Management

Oxygen and hemodynamic support
Immediate anticoagulation (unless contraindicated)
Systemic thrombolysis only in massive PE
Catheter-directed thrombolysis in intermediate-high-risk patients

Slide 9: Anticoagulation Treatment

First-line: Direct oral anticoagulants (DOACs) – Apixaban, Rivaroxaban
Alternative: LMWH (Enoxaparin), IV Heparin (especially if unstable)
Warfarin + bridge therapy: Used selectively

ASH 2020 Treatment Guidelines

Slide 10: What If Heparin Cannot Be Used?

Contraindication (e.g., HIT): Use Fondaparinux or DOAC
IVC filter only if anticoagulation is absolutely contraindicated

Slide 11: Duration of Anticoagulation

Provoked PE: 3 months
Unprovoked: Consider extended therapy
Cancer-associated: Minimum 6 months; typically LMWH or DOAC

Slide 12: Populations Requiring Special Consideration

Cancer patients: Prefer LMWH; some DOACs now approved
Older adults: Higher bleeding risk; adjust for renal function
Pregnancy: LMWH; DOACs contraindicated
Obesity: Weight-adjusted LMWH or higher fixed-dose DOACs

ASH, 2020; NEJM 2022; NIH Bookshelf (NBK560551)

Slide 13: Monitoring and Follow-Up

Labs: CBC, renal/liver function, aPTT (if on heparin), INR (if on warfarin)
Imaging only if symptoms worsen
Monitor for signs of bleeding or recurrent VTE

Slide 14: Patient Education

Medication adherence: Risk of recurrence if stopped early
Bleeding precautions: Avoid NSAIDs, alcohol, contact sports
DVT prevention: Hydration, mobility
When to call provider: SOB, chest pain, leg swelling, hemoptysis

Slide 15: Summary

Risk stratification is essential for accurate diagnosis
DOACs are first-line for most patients
Special populations need individualized care
Patient education improves adherence and outcomes

Slide 16: References (APA 7th Edition)

Konstantinides, S. V., et al. (2020). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. European Heart Journal, 41(4), 543–603. https://doi.org/10.1093/eurheartj/ehz405
American Society of Hematology. (2020). ASH Clinical Practice Guidelines on VTE. https://doi.org/10.1056/NEJMcp2116489
NIH. (2020). Pulmonary Embolism. In StatPearls. Diagnosis and Management of Pulmonary Embolism (PE). appeared first on Skilled Papers.