A pulmonary embolism is a blood clot, usually from a leg vein, that blocks an artery in the lungs. Many stable, low-risk patients can be diagnosed quickly and treated at home with oral anticoagulants.
Key symptoms
- Sudden shortness of breath
- Sharp chest pain on breathing in
- Cough, sometimes with blood
- Pain or swelling in one leg
- Lightheadedness or fainting
What you find on exam
- Fast heart rate and fast breathing
- Oxygen saturation
- Calf swelling or tenderness on one side
- Blood pressure and signs of right heart strain
Tests
- Wells score or PERC rule to estimate probability
- D-dimer if probability is low or moderate
- CT pulmonary angiogram; V/Q scan if contrast cannot be used
- ECG, troponin and BNP; sPESI score to decide on home treatment
Treatment basics
- Direct oral anticoagulant such as apixaban or rivaroxaban for at least 3 months
- Home treatment for low-risk patients (sPESI 0) with close follow-up
- Admit if unstable, low oxygen or high bleeding risk
- Thrombolysis with alteplase for massive PE with low blood pressure
- Teach bleeding warning signs and daily adherence
Red flags
- Low blood pressure or fainting
- Low oxygen or worsening breathlessness
- Major bleeding on anticoagulation
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.