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Pulmonary Embolism
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Diagnosis
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Pulmonary Embolism
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Prognosis

    Calc Function

  • Calcs that help predict probability of a diseaseDiagnosis
  • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
  • Disease is diagnosed: prognosticate to guide treatmentPrognosis
  • Numerical inputs and outputsFormula
  • Med treatment and moreTreatment
  • Suggested protocolsAlgorithm

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Advice

  • The 5 criteria are not of equal significance. The original article noted that HR and respiratory effort were most important, while color was least important.
    • To improve ease and utility, the criteria were not weighted for item importance.
  • The 5 minute score is regarded as the better predictor of survival.
  • Multiple publications from the American Congress of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) since 1996 including “Use and Abuse of APGAR” have emphasized limitations of APGAR to identify birth asphyxia and neurologic prognosis.
    • Score of 0-3 at ≥5 minutes is nonspecific marker of illness, “which may be one of the first indications of encephalopathy” but is not specific for asphyxia (Pediatrics 2015).
    • Asphyxia is only considered with evidence of impaired intrapartum or immediate postpartum gas exchange based on clinical condition and lab data.
      • Non-reassuring fetal HR tracings, imaging studies, EEG tracings, placental pathology may aid diagnosis.
    • Scores of ≤5 at 5 minutes and 10 minutes are associated with increased population risk of cerebral palsy (20-100 fold) and poor neurologic outcome, respectively.
      • Such population risks should not be extrapolated for any individual.

Management

  • Per NRP protocol, resuscitation should commence prior to 1 minute, so APGAR score should not dictate need for initial resuscitation or specific interventions.
  • A 2014 Neonatal Encephalopathy & Neurologic Outcome report defines 5 minute score of 7-10 as reassuring, 4-6 as moderately abnormal, and 0-3 as low.
  • If score is ≤5 at 5 minutes, obtain an umbilical artery (UA) blood gas.
  • 2015 ACOG/AAP publications and 2011 NRP reiterate that a score of 0 at 10 minutes may help decide whether continued resuscitative efforts are indicated due to poor prognosis.
  • Score during resuscitation is different than for a spontaneously breathing newborn.
    • Expanded score reporting during resuscitation is encouraged (Pediatrics 2015).
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