1. Physical Exam Findings
1.1. Hypoxia
1.2. Tachypnea
1.3. Increased work of breathing
1.4. Unilateral leg swelling
1.5. Cardiac arrest
2. Treatment Options
2.1. heparin --> warfarin
2.2. low-molecular weight heparin
2.3. direct-acting oral anticoagulant
2.4. what if massive PE? (hypotension/unstable)
2.4.1. thrombolysis
2.4.2. thrombectomy
2.4.2.1. IR or surgery?
3. Risk Stratification (Once Diagnosed)
3.1. PESI score
3.2. Hestia criteria
3.2.1. can the pt potentially get outpatient treatment?
4. Historical Findings
4.1. Chest pain
4.1.1. what "type" of chest pain?
4.2. Dyspnea/SOB
4.2.1. new?
4.3. Lower extremity pain/swelling
4.4. Oral contraceptive use
4.4.1. what type of OCP?
4.5. History of deep vein thrombosis
4.5.1. family history of recurrent DVTs?
4.6. History of malignancy
4.6.1. within 6 months?
4.7. Tobacco use
4.8. Recent surgery or trauma
4.8.1. within 4 weeks?
4.9. Recent immobilization
4.9.1. immobilized for more than 3 days?
5. Risk Stratification (Diagnosis)
5.1. PERC Criteria
5.1.1. if PERC negative, <2% chance of PE
5.2. Wells Score
5.2.1. Two-tier vs. three-tier model
5.3. Geneva Score
6. Investigations
6.1. EKG
6.1.1. S1Q3T3
6.1.2. Sinus tachycardia
6.1.3. Nonspecific TWI
6.1.4. Right heart strain
6.1.5. Normal
6.2. Chest XR
6.2.1. Normal
6.2.2. Hampton's hump
6.2.3. Westermark's sign
6.3. D-dimer
6.3.1. very high sensitivity, very low spevificity
6.3.2. use in pts with low/moderate suspicion
6.4. Ct-angiogram
6.4.1. requires IV contrast and radiation
6.4.1.1. renal failure?
6.4.1.2. multiple CT's in past?
6.4.1.3. pregnancy implications?
6.4.2. use in pts with higher suspicion
6.5. Ventilation/perfusion scan
6.5.1. accuracy/availability
6.5.2. alternative if pt not candidate for CT
6.6. Cardiac ultrasound
6.6.1. dilated right ventricle
6.6.2. bowing of interventricular septum
6.6.3. McConnell's sign