الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Data as presented in the original studies was collected from various resources as from various sources including journals as Emergency Medicine Journal (EMJ), European Journal of Emergency Medicine, Western Journal of Emergency Medicine (WestJEM), LANCET, British Medical Journal (BMJ), Journal of American Medical Association (JAMA), The آNew England Journal of Medicine (NEJM), American Journal of Respiratory and Critical Care Medicine, Thorax, The British Thoracic Association, Textbooks as Current Emergency Medicine, Oxford Emergency Medicine, First Aid for the Emergency Medicine Board, and Medical libraries as Suez Canal University Hospital, Kasr El Ainy Hospital And Ain Shams University to Review the updates of the guidelines in the management of pulmonary embolism and to explore the most recent general and emergency lines of treatment of pulmonary embolism cases and recognize the impact of these measures on the outcome prognosis
In this review, we found that the diagnostic algorithm in patients with suspected pulmonary embolism in a patient without hypotension or shock include evaluation of the clinical probability score, the use of D-dimer assay and multidetector CT, while in patients with suspected pulmonary embolism with hypotension or shock, multidetector CT is done immediately if available, if not echocardiography should be used.(29)
Regarding the preventive measures of pulmonary embolism, The risk of venous thromboembolism is substantial in hospitalized patients but can be reduced significantly when patients receive appropriate prophylaxis (43) Heparin, low-molecular-weight heparin, fondaparinux, warfarin, and mechanical prophylaxis have proven effective in various clinical settings. Unfortunately, prophylactic measures appear to be grossly underused, as determined in both U.S. and international studies.
Treatment options include hemodynamic support as Acute RV failure with resulting low systemic output is the leading cause of death in patients with high-risk PE, this is done by maintaining oxygenation using nasal oxygen, mechanical ventilation may rarely be necessary, fluid infusion, cardiac support, vasodilators and nitric oxide should be considered.
Rapid anticoagulation with parenteral anticoagulants, such as intravenous unfractionated heparin, subcutaneous low-molecular-weight heparin (LMWH) or subcutaneous fondaparinux should be achieved (56), this should be followed by parenteral anticoagulants is usually followed by the administration of oral vitamin K antagonists (VKAs).(3)
Intravenous unfractionated heparin dosage is adjusted based on the activated partial thromboplastin time
Randomized trials have consistently shown that thrombolytic therapy rapidly resolves thromboembolic obstruction and exerts beneficial effects on haemodynamic parameters. (3)
With regard to the comparison of different thrombolytic agents, the Urokinase Streptokinase Pulmonary Embolism Trial (USPET) documented equal efficacy of Urokinase and Streptokinase infused over a period of 12–24 h.246. (3)
Contraindications to thrombolysis that are considered absolute, e.g. in acute myocardial infarction, might become relative in a patient with immediately life-threatening high-risk PE. (3)
Placement of a Vena Caval Filter and Surgical treatment as surgical pulmonary embolectomy or Percutaneous catheter embolectomy and fragmentation should be considered.
Patients with acute venous thromboembolism require long-term anticoagulation to prevent symptomatic extension and recurrence of thrombosis. (3) VKAs are used in the vast majority of patients, while LMWH may be an effective and safe alternative to VKAs in cancer patients.