PedsCrit

Pulmonary Embolism with Ayesha Zia

Mar 23, 2026
Guest
Ayesha Zia
Ayesha Zia, pediatric hematologist and thrombosis expert at UT Southwestern, discusses pediatric pulmonary embolism. She covers early warning signs in children. She explains limits of clinical rules and D-dimer, risk stratification, and the role of echo and CT. She describes multidisciplinary PERT teams, reperfusion choices, anticoagulation timing, ECMO use, and key ICU considerations.
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ADVICE

Start Heparin Immediately And Risk Stratify

  • Start anticoagulation promptly (usually IV heparin) once PE is diagnosed unless contraindicated.
  • Simultaneously assess hemodynamics, cardiac biomarkers, and get an echocardiogram to risk-stratify.
INSIGHT

CT RV:LV Ratio Helps But Echo Is Gold Standard

  • CT-derived RV:LV ratio has value and radiology often reports it, but it doesn't always correlate with echo; echo remains the gold standard.
  • For peripheral subsegmental PE with normal other data, echo can be deferred.
ADVICE

Use Risk Categories To Guide Escalation

  • Risk-stratify PE: high risk = sustained hypotension or cardiovascular collapse; intermediate-high = RV dysfunction plus elevated biomarkers; intermediate-low = one or the other.
  • Use these categories to guide escalation beyond anticoagulation.
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