Pulmonary Embolus

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  • if +PE, sPESI score to see if can discharge from ED
Hand Drawn Basic Abstract Shape

Low suspicion of PE:

  • PERC rule
  • if zero, no D-dimer or CT
  • meta-analysis of 12 studies ​found that if PERC applied, ​only 0.3% of PEs would ​have been missed & 22% of ​D-dimer testing safely ​avoided




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If low PE risk with PERC>0:

  • D-dimer
    • Neg= no further tests
    • Pos= imaging
  • only consider D-dimer with ​moderate pre-test ​probability
  • with high pre-test ​probability go right to ​imaging.




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Well’s criteria for PE & DVT

  • DVT> 1 pt then get U/S
  • PE
    • <= 4, PE unlikely, ​get d-dimer
    • 4-6, mod possibility ​PE
    • >6, high prob PE

DVT

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Hand Drawn Basic Abstract Shape

Lower Extremity DVT:

  • Proximal- popliteal, ​femoral, iliac veins
  • Distal- calf veins ​(peroneal, posterior & ​anterior tibial)