We review the diagnosis, risk stratification, & management of acute pulmonary embolism in the ED.
Hosts:
Vivian Chiu, MD
Brian Gilberti, MD
Show Notes
Core Concepts and Initial Approach
- Definition: Obstruction of pulmonary arteries, usually from a DVT in the proximal lower extremity veins (iliac/femoral), but may be tumor, air, or fat emboli.
- Incidence & Mortality: 300,000–370,000 cases/year in the USA, with 60,000–100,000 deaths annually.
- Mantra: “Don’t anchor on the obvious. Always risk stratify and resuscitate with precision.”
- Risk Factors: Broad, including older age, inherited thrombophilias, malignancy, recent surgery/trauma, travel, smoking, hormonal use, and pregnancy.
Clinical Presentation and Risk Stratification
- Presentation: Highly variable, showing up as anything from subtle shortness of breath to collapse.
- Acute/Subacute: Dyspnea (most common), pleuritic chest pain, cough, hemoptysis, and syncope. Patients are likely tachycardic, tachypneic, hypoxemic on room air, and may have a low-grade fever.
- Chronic: Can mimic acute symptoms or be totally asymptomatic.
- Pulmonary Infarction Signs: Pleuritic pain, hemoptysis, and an effusion.
- High-Risk Red Flags: Signs of hypotension (systolic blood pressure < 90 mmHg for over 15 minutes),
