|
 | Presentation
 | Tachypnea, dyspnea, tachycardia, "feeling of impending
doom." |
|
| History
| Onset, duration, fever, N/V, cough, hemoptysis |
| Inactivity? |
| PMH: DM, obesity, recent surgery, trauma, fracture,
immobilization |
| H/O DVTs, heart disease, previous PE |
| Medications: incl. OCPs, HRT |
|
| PE
| HEENT |
| CV: Kussmaul's respirations, pulsus paradoxus,
auscultate |
| Lungs: inspiratory crackles, localized wheeze |
| Ext: Homan's sign (pain in calf with dorsiflexion
of foot), measure calves bilaterally, edema. |
|
| DDx
| PE, COPD exacerbation, pneumothorax, pneumonia, ARDS |
| AMI, cardiac tamponade, CHF |
| Dissecting AAA |
| Panic attack |
|
| Laboratory
| EKG, CXR, ABG (respiratory alkalosis) |
| CBC w/ diff, BMP, coags, UA, D-dimer |
| Dopper US of legs (V/Q scan?) |
| Spiral CT? |
| Pulmonary angiogram is gold standard |
|
| Treatment
| Admit to ICU |
| tPA if hypotensive |
| Oxygen, heparin, coumadin |
| Morphine |
| TED hose |
| NSAIDS for pleuritic pain |
| Possible surgical embolectomy |
|
| Miscellaneous
| Think PE if...
 | unexplained worsening of CHF, COPD |
| unexplained new-onset supraventricular tachycardia |
|
| Virchow's triad
| Abnormal blood vessels |
| Venous stasis |
| Hypercoagulable state |
|
|
|
