Pulmonary Embolism Response Team (PERT)

A pulmonary embolism (PE) is a blood clot in the lungs that typicallyÌýdevelops in the leg and then travels to the lungs.Ìý After reaching the lungs, it causes damage by blocking blood flow within the lungs. Signs and symptoms of a pulmonary embolism may vary depending on the size and location of the clot and may include;Ìý

  • Shortness of breath (most common); may worsen with physical activityÌý
  • Chest pain (may worsen with breathing)Ìý
  • ¹ó²¹¾±²Ô³Ù¾±²Ô²µÌý
  • Coughing and/or coughing up bloodÌýÌý
  • Rapid or irregular heartbeatÌý
  • Lightheadedness/ syncope (passing out)Ìý
  • Feeling anxiousÌý

PE’s are dangerous,Ìýpotentially deadly and require immediate medical attention.

For more information on PE clickÌýHEREÌý

Here at Stony Brook, we have a specialized Pulmonary Embolism Response Team (PERT Team) that cares for patients diagnosed with a Pulmonary Embolism. Members of the PERT team include specialists from Pulmonary and Critical Care, Emergency Medicine, Interventional Radiology, Vascular Surgery, Cardiothoracic Surgery, Hematology and Internal Medicine. This group of specialized providers collaborate to rapidly evaluate and assess the need for advanced treatment plans for pulmonary embolism patients, particularly those with acute PE. Additionally, the PERT team helps provide long-term follow-up care after patients are discharged.Ìý

PERT team
Dr. Daniel Ohngemach, Interventional Radiology, Dr. Sidra Tahseen, Critical Care, Kristan Probeck, NP, Vascular Surgery, Dr. Anish Desai, Pulmonary and Critical Care, Doreen Elitharp, NP, Vascular Surgery, Dr. Apostolos Tassiopolous, Chief, Vascular Surgery and Endovasuclar Surgery

Your health care provider will obtain your medical history and perform a physical examination.Ìý

Testing to diagnose a PE may include the following:ÌýÌý

  • Computed tomographic angiography (CTPA)- special type of x-ray that uses dye/ contrast to look at the blood vessels in your lungs.ÌýÌýÌý
  • Pulmonary V/Q scan - shows which part of your lung is getting airflow (ventilation) and blood flow (perfusion).ÌýÌýÌý

Additional testing also includes:

  • Echocardiogram - a non-invasive ultrasound imaging test that provides detailed images of the heart structure and function by using soundwaves.Ìý A probe is placed on the outside of the chest, and images are collected.ÌýThis is a valuableÌýdiagnostic tool for detecting strain on the heart caused by a developing pulmonary embolism (PE) or identifying any free-floating clot.ÌýÌý
  • Doppler ultrasound of the legs - a non-invasive ultrasound imaging test that is used to diagnose a blood clot formed in the legs known as a deep vein thrombosis (DVT)Ìý
  • Blood tests areÌýconducted to assess any stress on the heart, evaluateÌýthe blood’s clotting ability, and identify genetic disorders that may contribute to abnormal clotting. Arterial blood gases may also checked to analyze the amountÌýof oxygen in the blood.Ìý

If you are found to have a PE and theÌýadditional testing raises concerns, the pulmonary critical care team is alerted and promptly arrive to the bedside to evaluate you.Ìý If after assessmentÌýyour PE is considered at an intermediate or high risk by the Pulmonary Critical Care team, a PERT alert is activated.Ìý

The location and severity of your PE will then determine which PERT team specialist will arrive to your bedside next.

The following specialists can be called.Ìý

  • Interventional Radiology specialists perform procedures that use continuous x-rays to help guide a catheter (small tube) to your lungs to retrieve the clot or to infuse a special blood thinning medication at the site of the clot.Ìý Sometimes a filter is placed to preventÌýa blood clot from travelingÌýfrom yourÌýlegs to the lungs. More information on these procedures is available below.
    • Catheter directed thrombolytic therapy- for more information click HEREÌý
    • Mechanical thrombectomy- for more information click HEREÌý
    • Inferior Vena Cava filter placement- for more information click
  • Vascular Surgery specialists may perform a procedure if you have a large blood clot in your leg to remove it.Ìý The vascular team may also place a filter to prevent a blood clot from traveling from your leg to your lungs.
  • Cardiothoracic Surgery specialists are available for severe cases of PEs where you may need to be placed on a heart and lung machine which will help move oxygen throughout your body.ÌýThe cardiothoracic surgery team may also determine to perform a surgical embolectomy where they make an incision through the chest wall to remove the clot surgically.
    • ECMO- click
  • The Emergency Medicine and Internal Medicine specialists may also determine if the PE is severe enough to require that a clot busting medication, such as tPA (tissue plasminogen activator) or TNK (tenecteplase) be given immediately.
    • For more information on systemic thrombolytics click HERE

Once the PERT team determines you are not in any immediate danger and do not need any of the advanced interventions above, blood thinners are continued to help treat the PE in the hospital and then continued for 3-6 months after you are discharged. Be sure to take this medication as directed by your provider, do not miss any doses, and do not stop taking your medication unless directed by your healthcare provider.Ìý Follow up with your primary care practitioner within 1 week of discharge.Ìý You should also be further evaluated in the pulmonary embolism clinic within 1 month after discharge to make sure your lungs are improving.Ìý