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Monday, September 27, 2021

Pulmonary embolism

emDocs - Septiember 27, 2021 - By Anita Bhamidipati; Sumaya Mekkaoui
Reviewed by: Courtney Cassella; Alex Koyfman; Brit Long
“Take Home Points
  1. Patients may present with vague symptoms. The most common symptom of PE is dyspnea. This is more common than chest pain or hemoptysis. Pay attention to unexplained dyspnea or breathlessness.
  2. Delayed diagnosis leads to worse outcomes even in patients that are admitted to the hospital.
  3. Physical exam most commonly reveals tachypnea, followed by tachycardia. PE should also be on your differential when you note JVD, tachypnea and tachycardia on exam.
  4. POCUS is a great adjunct to the clinical exam and is helpful in determining if there are signs of right ventricular strain (RV-strain). POCUS can assist in making important decisions regarding diagnosis and treatment sometimes faster than CT scans. Use this to your advantage!
  5. Certain EKG findings may help you to consider the diagnosis in the right clinical context. The most common EKG finding in PE is tachycardia. The most specific EKG finding is anteroinferior TWIs. STE in V1, RBBB and right-axis deviation are among others.
  6. Clinical decision tools are just that: they are “tools,” not “rules” and should not replace clinical judgment. Do not anchor on a diagnosis. Rely on your clinical history and exam and use these as adjuncts.”