Pulmonary embolism (PE)

Diagnostic and therapeutic approach

Diagnosis

Probability of pulmonary embolism

If high probability do CT scan.

Low or intermediate probability dose D-dimers. If D-dimers normal no treatment if D-dimers augmented CT scan or echocardiography.

If diagnosis of pulmonary embolism confirmed or probable estimate the risk to start treatment.

  • BP > 90 mm Hg, biomarkers and echo negatives, low risk.
  • BP > 90 mm Hg, biomarkers high (BNP, troponine) and positive echocardiography, intermediate risk.
  • BP < 90 mm Hg, shock, resuscitation high risk.

Clinical signs

  • Tachycardia. Sometimes AF.
  • Hypoxemia
  • Negative T waves from V1 to V3
  • S1, Q3 and T3 waves.