Pulmonary Embolism

📧 EM Note Newsletter https://forms.gle/8boToiKDXVE3V8U19 Signup to get free weekly PDF via email. PS: Please join our membership for more perks (members can request for specific PDF file by posting in the EM Note YouTube Membership section). Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls Pulmonary embolism (PE) is a blockage of the pulmonary artery, typically originating as an embolus from a deep vein thrombosis (DVT). Clinical management begins with an ABCDE assessment to determine if the patient is stable. Unstable patients require immediate stabilization of the airway and circulation, followed by an emergent CT pulmonary angiography (CTPA). If PE is confirmed, unstable patients receive thrombolytic therapy, or surgical/catheter embolectomy if bleeding risks are present. Stable patients are evaluated using the Wells criteria to stratify risk: Low probability (Score less than 2): Use the PE rule-out criteria (PERC). If fulfilled, PE is ruled out; otherwise, assess D-dimer levels. Moderate probability (Score 2–6): Check D-dimer. Levels below 500 ng/mL rule out PE, while levels above 500 ng/mL require a CTPA. High probability (Score greater than 6): Immediately initiate anticoagulation therapy (usually DOACs) and order a CTPA. A positive CTPA confirms the diagnosis, while inconclusive results may necessitate a ventilation-perfusion (V/Q) scan or lower extremity ultrasound. Confirmed PE is treated with ongoing anticoagulation.