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Suspected Pulmonary Embolism PresentationAPPROACH

RESPIRATORY · 19 SECTIONS

⚲

431 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Wheezing, Undifferentiated Wheezing In Infants Stridor And Upper Airway Symptoms Dyspnea Aspiration Event Cough Hemoptysis Upper Respiratory Infection Symptoms Suspected Pulmonary Embolism Presentation Smoke Inhalation Concern Smoke Exposure And Inhalational Injury

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx43

Presenting symptoms and timeline

›Symptom overview

›Dyspnea

›Pleuritic chest pain

›Hemoptysis

›Syncope

›Unilateral leg pain or swelling

›Palpitations

›Fever context

OPQRST

›Onset

›Sudden

›Gradual

›Provocation or palliation

›Worse with inspiration

›Worse with exertion

›Relief with rest

›Quality

›Sharp

›Pressure

›Tightness

›Region or radiation

›Lateral chest

›Substernal

›Severity

›Functional limitation

›Activity tolerance change

›Timing

02Alarm Features/alarm16

Immediate life threats and escalation triggers

›High risk presentation

›SBP less than 90 mmHg

›SBP drop at least 40 mmHg for at least 15 minutes

›Persistent tachycardia with signs of shock

›Severe hypoxemia despite oxygen

›Altered mental status

›Cardiac arrest or peri arrest physiology

High risk bleeding and anticoagulation hazards

›Major bleeding risk features

›Active bleeding

›Recent intracranial hemorrhage

›Recent major surgery or trauma

›Known intracranial lesion

High risk alternate diagnoses

›Mimic red flags

›STEMI pattern symptoms

›Tension pneumothorax signs

›Aortic dissection features

03Medications/meds19

Current and recent medications

›Antithrombotics

›DOAC use

›Warfarin use

›Antiplatelet use

›Hormonal exposure

›Combined oral contraceptives

›Estrogen therapy

Contraindications and interactions relevant to treatment

›Anticoagulation interaction risks

›Strong CYP3A4 or P gp inhibitors

›Strong CYP3A4 or P gp inducers

›Bleeding risk amplifiers

›NSAID use

›SSRI or SNRI use

Adherence and recent changes

›Anticoagulant adherence

›Missed doses

›Recent interruption

›Recent medication changes

›New hormones

›New chemo or immunotherapy

04Diet/diet12

Hydration and intake patterns

›Volume status cues

›Poor oral intake

›Vomiting or diarrhea

›Caffeine exposure

›High intake

›Energy drink use

Alcohol exposure when relevant

›Recent alcohol intake

›Heavy intake

›Withdrawal risk

Diet related contributors to symptoms

›Anemia and bleeding context

›Poor nutrition pattern

›GI bleeding symptoms context

05Review of Systems/ros21

Cardiopulmonary

›Cardiopulmonary symptoms

›Chest pain

›Dyspnea

›Cough

›Hemoptysis

›Wheeze

›Palpitations

›Syncope

Vascular and limb

›DVT symptoms

›Unilateral leg swelling

›Leg pain

›Calf tenderness

›Skin warmth

Infection and inflammatory

›Systemic symptoms

›Fever

›Chills

›Malaise

Neuro

›Neuro symptoms

›Headache new or severe

›Focal deficits

›Seizure

06Collateral History and Family History/chafh9

Collateral source and reliability

›Collateral information

›Witness account for syncope

›Medication list confirmation

Family history relevant to thrombosis

›Thrombotic history

›VTE in first degree relative

›VTE at young age in family

Household and exposure context

›Exposure context

›Sick contacts

›Recent immobilization at home support limitations

07Risk Factors/rf22

Venous thromboembolism risks

›Transient provoking factors

›Surgery within 4 weeks

›Trauma within 4 weeks

›Immobilization at least 3 days

›Long travel at least 4 hours

›Persistent risks

›Active cancer

›Pregnancy and postpartum

›Estrogen exposure

›Prior VTE

Cardiopulmonary reserve and vulnerability

›Limited reserve

›COPD

›Heart failure

›Pulmonary hypertension

Bleeding risk factors

›Bleeding risk

›Recent GI bleeding

›Thrombocytopenia history

›Severe renal impairment

›Severe liver disease

Device and procedure related risks

›Intravascular and device risks

›Central venous catheter

›Recent pacemaker or ICD leads

08Differential Diagnosis/ddx53

Life threatening

›Life threatening causes

›Pulmonary embolism (I26.99)

›Pleuritic pain

›Hypoxemia

›Tachycardia

›Acute coronary syndrome (I21.9)

›Pressure chest pain

›Diaphoresis

›Aortic dissection (I71.00)

›Tearing pain

›Pulse deficit

›Tension pneumothorax (J93.0)

›Unilateral absent breath sounds

›Tracheal deviation

›Massive hemoptysis airway threat (R04.2)

›Large volume bleeding

›Respiratory distress

Common

›Common causes

›Pneumonia (J18.9)

›Fever

›Focal crackles

›COPD exacerbation (J44.1)

›Wheeze

›Hypercapnia risk

›Heart failure (I50.9)

›Orthopnea

09Past Medical History/pmh17

Thrombotic and bleeding history

›Prior thrombosis

›Prior PE

›Prior DVT

›Known thrombophilia

›Prior bleeding

›Intracranial hemorrhage

›GI bleeding

Cardiopulmonary comorbidity

›Reserve limiting conditions

›Heart failure

›COPD

›Chronic kidney disease

Surgeries and procedures

›Recent procedures

›Recent surgery

›Recent invasive procedures

Baseline function

›Baseline functional status

›Mobility limitations

›Home oxygen use

10Physical Exam/exam29

General and vital sign patterns

›General appearance

›Toxic appearance

›Increased work of breathing

›Vital signs

›Hypoxemia

›Tachycardia

›Hypotension

›Fever

Hemodynamics and perfusion

›Perfusion and shock markers

›Cool extremities

›Delayed capillary refill

›Oliguria

Lungs

›Respiratory exam

›Tachypnea

›Wheeze

›Crackles

›Unilateral decreased breath sounds

Heart and neck

›Cardiovascular exam

›Loud P2

›New murmur

›JVP elevation

›RV heave

Extremities and DVT signs

›Lower limb exam

11Lab Studies/labs21

Core labs for PE pathway and safety

›Baseline and safety labs

›CBC

›Electrolytes and creatinine

›AST ALT bilirubin

›PT INR

›aPTT

D dimer strategy

›D dimer use

›Only in low or intermediate pretest probability

›Not for high pretest probability

›D dimer interpretation

›Age adjusted threshold for patients older than 50 years

›Pregnancy and postpartum limitations

Cardiac strain and alternative diagnosis support

›RV strain labs

›Troponin

›BNP or NT proBNP

›Shock and perfusion labs

›Lactate

›Venous blood gas when severe distress

Pregnancy and special populations

›Pregnancy testing

›Urine or serum beta hCG if pregnancy possible

›Rh status only if bleeding or pregnancy complications suspected

12Imaging/img34

Scoring Systems

›Pretest probability and rule out tools

›Wells criteria for PE

›Low probability pathway supports D dimer strategy

›High probability pathway supports direct imaging

›Revised Geneva score

›Objective variable scoring

›D dimer pathway when low or intermediate

›PERC rule

›Only when clinician gestalt low risk

›Requires all criteria negative to avoid D dimer

›YEARS algorithm

›Integrates clinical items with variable D dimer thresholds

›Pregnancy adapted variants local protocol dependent

›PESI and sPESI

›Risk stratifies mortality for disposition planning

›Not a rule out test

MRI

›MRI pulmonary angiography

›Limited availability and variable accuracy

›Consider when iodinated contrast contraindicated and local expertise present

›CT pulmonary angiography

›First line imaging for most nonpregnant adults

›Evaluate alternative diagnoses

›Contrast and radiation cautions

›Severe renal impairment risk discussion

›Anaphylactoid reaction history and premedication protocols local

13Special Tests/spec10

Bedside echocardiography and strain assessment

›Echocardiography

›RV dilation

›RV dysfunction

›Septal flattening

Gas exchange testing

›Arterial blood gas in selected cases

›Severe hypoxemia evaluation

›Hypercapnia suggests alternate diagnosis or fatigue

Thrombophilia testing cautions

›Thrombophilia testing

›Not for acute ED decision making

›Defer to outpatient hematology when indicated

14ECG/ecg14

PE associated ECG patterns and alternate diagnoses

›Common ECG findings

›Sinus tachycardia

›Nonspecific ST T changes

›RV strain patterns

›Right axis deviation

›RBBB

›T wave inversions V1 to V4

›S1Q3T3

High risk ECG triggers

›Concerning patterns

›New RBBB with shock physiology

›Ischemic changes suggesting ACS

Serial ECG logic

›Serial ECG

›Persistent chest pain or evolving symptoms

›Troponin positive pathway

15Assessment/ax16

Working diagnosis and pretest probability

›Suspected pulmonary embolism (I26.99)

›Pretest probability category

›Rule out pathway eligibility

Severity stratification

›Hemodynamic classification

›Massive PE

›Submassive PE

›Low risk PE

›RV strain evidence

›Troponin elevation

›BNP elevation

›Echo RV dysfunction

Diagnostic uncertainty and alternatives

›Competing diagnoses

›Pneumonia

›ACS

›Heart failure

›Pneumothorax

16Plan/plan43

Differential Management

›!Pulmonary embolism→›!Acute coronary syndrome (NSTEMI)→›Spontaneous pneumothorax→

Approach to critical patient

›First 5 minutes workflow

›Continuous monitoring

›Two large bore IV access

›Oxygen to target SpO2 at least 92 percent

›If shock, vasopressor support

›Early bedside echo when unstable

Diagnostic sequencing

›Testing pathway

›If low risk and PERC negative, no further PE testing

›If low or intermediate risk, D dimer strategy

›If D dimer positive, imaging

›If high risk, direct imaging

Anticoagulation and reperfusion

›Anticoagulation initiation

›If high suspicion and imaging delayed with acceptable bleeding risk, initiate anticoagulation

›If active bleeding or major contraindication, hold anticoagulation and escalate for alternatives

›UFH infusion when high risk or procedures anticipated

›Bolus dosing local protocol dependent

›Infusion titration to aPTT or anti Xa target local protocol dependent

›LMWH example dosing when appropriate

›Enoxaparin 1 mg per kg subcut every 12 hours

›Avoid in severe renal impairment without adjustment

›DOAC initiation when appropriate and stable

17Disposition/dispo21

ICU and high acuity criteria

›ICU level care

›Persistent hypotension

›Vasopressor requirement

›Need for thrombolysis or catheter intervention

›Severe hypoxemia requiring high level respiratory support

Inpatient admission criteria

›Admission appropriate

›RV dysfunction on echo

›Troponin or BNP elevated with PE

›PESI high risk or sPESI at least 1

›Significant comorbid disease

Observation or outpatient pathway

›Low risk disposition tools

›sPESI 0 supports low risk selection

›Hestia criteria supports outpatient eligibility

›Discharge criteria

›Stable vitals

›Low bleeding risk

›Reliable follow up within 24 to 72 hours

›Anticoagulation access confirmed

Transfer criteria

›Transfer to higher level center

›Need for catheter directed therapy not available locally

›Need for ECMO capability in refractory shock

18Discharge Instructions/di13

Copy discharge instructions

›Patient instructions

›You were evaluated for a blood clot in the lung called a pulmonary embolism

›Your risk level today is low and you are safe to go home with close follow up

›Take your blood thinner exactly as prescribed

›Do not miss doses

›Avoid NSAIDs unless your clinician says they are safe with your blood thinner

›Seek urgent care for bleeding that does not stop

›Return to the ED now for worsening shortness of breath

›Return to the ED now for chest pain

›Return to the ED now for fainting

›Return to the ED now for coughing up blood

›Follow up with your clinician within 24 to 72 hours

›Discuss how long you need to be on the blood thinner at follow up

19References/r18

Guidelines and decision tools

›European Society of Cardiology guideline for acute pulmonary embolism 2019

›Risk stratification and management pathways

›Imaging and anticoagulation recommendations

›CHEST guideline and expert panel report antithrombotic therapy for VTE disease 2021

›DOAC first line for many patients

›Duration of therapy framework

›American Society of Hematology guideline for management of VTE 2018

›Anticoagulation selection and duration concepts

›Thrombolysis and IVC filter considerations

›ACEP clinical policy suspected acute venous thromboembolic disease 2018

›PERC and D dimer strategy context

›Imaging decision support

›YEARS diagnostic algorithm studies 2017 and later validations

›Variable D dimer threshold strategy

›Reduced imaging in selected cohorts

›PESI and simplified PESI validation studies

›Mortality risk stratification

›Outpatient selection support

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Suspected Pulmonary Embolism PresentationAPPROACH

RESPIRATORY · 19 SECTIONS

⚲

431 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx43

Presenting symptoms and timeline

›Symptom overview

›Dyspnea

›Pleuritic chest pain

›Hemoptysis

›Syncope

›Unilateral leg pain or swelling

›Palpitations

›Fever context

OPQRST

›Onset

›Sudden

›Gradual

›Provocation or palliation

›Worse with inspiration

›Worse with exertion

›Relief with rest

›Quality

›Sharp

›Pressure

›Tightness

›Region or radiation

›Lateral chest

›Substernal

›Severity

›Functional limitation

›Activity tolerance change

›Timing

02Alarm Features/alarm16

Immediate life threats and escalation triggers

›High risk presentation

›SBP less than 90 mmHg

›SBP drop at least 40 mmHg for at least 15 minutes

›Persistent tachycardia with signs of shock

›Severe hypoxemia despite oxygen

›Altered mental status

›Cardiac arrest or peri arrest physiology

High risk bleeding and anticoagulation hazards

›Major bleeding risk features

›Active bleeding

›Recent intracranial hemorrhage

›Recent major surgery or trauma

›Known intracranial lesion

High risk alternate diagnoses

›Mimic red flags

›STEMI pattern symptoms

›Tension pneumothorax signs

›Aortic dissection features

03Medications/meds19

Current and recent medications

›Antithrombotics

›DOAC use

›Warfarin use

›Antiplatelet use

›Hormonal exposure

›Combined oral contraceptives

›Estrogen therapy

Contraindications and interactions relevant to treatment

›Anticoagulation interaction risks

›Strong CYP3A4 or P gp inhibitors

›Strong CYP3A4 or P gp inducers

›Bleeding risk amplifiers

›NSAID use

›SSRI or SNRI use

Adherence and recent changes

›Anticoagulant adherence

›Missed doses

›Recent interruption

›Recent medication changes

›New hormones

›New chemo or immunotherapy

04Diet/diet12

Hydration and intake patterns

›Volume status cues

›Poor oral intake

›Vomiting or diarrhea

›Caffeine exposure

›High intake

›Energy drink use

Alcohol exposure when relevant

›Recent alcohol intake

›Heavy intake

›Withdrawal risk

Diet related contributors to symptoms

›Anemia and bleeding context

›Poor nutrition pattern

›GI bleeding symptoms context

05Review of Systems/ros21

Cardiopulmonary

›Cardiopulmonary symptoms

›Chest pain

›Dyspnea

›Cough

›Hemoptysis

›Wheeze

›Palpitations

›Syncope

Vascular and limb

›DVT symptoms

›Unilateral leg swelling

›Leg pain

›Calf tenderness

›Skin warmth

Infection and inflammatory

›Systemic symptoms

›Fever

›Chills

›Malaise

Neuro

›Neuro symptoms

›Headache new or severe

›Focal deficits

›Seizure

06Collateral History and Family History/chafh9

Collateral source and reliability

›Collateral information

›Witness account for syncope

›Medication list confirmation

Family history relevant to thrombosis

›Thrombotic history

›VTE in first degree relative

›VTE at young age in family

Household and exposure context

›Exposure context

›Sick contacts

›Recent immobilization at home support limitations

07Risk Factors/rf22

Venous thromboembolism risks

›Transient provoking factors

›Surgery within 4 weeks

›Trauma within 4 weeks

›Immobilization at least 3 days

›Long travel at least 4 hours

›Persistent risks

›Active cancer

›Pregnancy and postpartum

›Estrogen exposure

›Prior VTE

Cardiopulmonary reserve and vulnerability

›Limited reserve

›COPD

›Heart failure

›Pulmonary hypertension

Bleeding risk factors

›Bleeding risk

›Recent GI bleeding

›Thrombocytopenia history

›Severe renal impairment

›Severe liver disease

Device and procedure related risks

›Intravascular and device risks

›Central venous catheter

›Recent pacemaker or ICD leads

08Differential Diagnosis/ddx53

Life threatening

›Life threatening causes

›Pulmonary embolism (I26.99)

›Pleuritic pain

›Hypoxemia

›Tachycardia

›Acute coronary syndrome (I21.9)

›Pressure chest pain

›Diaphoresis

›Aortic dissection (I71.00)

›Tearing pain

›Pulse deficit

›Tension pneumothorax (J93.0)

›Unilateral absent breath sounds

›Tracheal deviation

›Massive hemoptysis airway threat (R04.2)

›Large volume bleeding

›Respiratory distress

Common

›Common causes

›Pneumonia (J18.9)

›Fever

›Focal crackles

›COPD exacerbation (J44.1)

›Wheeze

›Hypercapnia risk

›Heart failure (I50.9)

›Orthopnea

09Past Medical History/pmh17

Thrombotic and bleeding history

›Prior thrombosis

›Prior PE

›Prior DVT

›Known thrombophilia

›Prior bleeding

›Intracranial hemorrhage

›GI bleeding

Cardiopulmonary comorbidity

›Reserve limiting conditions

›Heart failure

›COPD

›Chronic kidney disease

Surgeries and procedures

›Recent procedures

›Recent surgery

›Recent invasive procedures

Baseline function

›Baseline functional status

›Mobility limitations

›Home oxygen use

10Physical Exam/exam29

General and vital sign patterns

›General appearance

›Toxic appearance

›Increased work of breathing

›Vital signs

›Hypoxemia

›Tachycardia

›Hypotension

›Fever

Hemodynamics and perfusion

›Perfusion and shock markers

›Cool extremities

›Delayed capillary refill

›Oliguria

Lungs

›Respiratory exam

›Tachypnea

›Wheeze

›Crackles

›Unilateral decreased breath sounds

Heart and neck

›Cardiovascular exam

›Loud P2

›New murmur

›JVP elevation

›RV heave

Extremities and DVT signs

›Lower limb exam

11Lab Studies/labs21

Core labs for PE pathway and safety

›Baseline and safety labs

›CBC

›Electrolytes and creatinine

›AST ALT bilirubin

›PT INR

›aPTT

D dimer strategy

›D dimer use

›Only in low or intermediate pretest probability

›Not for high pretest probability

›D dimer interpretation

›Age adjusted threshold for patients older than 50 years

›Pregnancy and postpartum limitations

Cardiac strain and alternative diagnosis support

›RV strain labs

›Troponin

›BNP or NT proBNP

›Shock and perfusion labs

›Lactate

›Venous blood gas when severe distress

Pregnancy and special populations

›Pregnancy testing

›Urine or serum beta hCG if pregnancy possible

›Rh status only if bleeding or pregnancy complications suspected

12Imaging/img34

Scoring Systems

›Pretest probability and rule out tools

›Wells criteria for PE

›Low probability pathway supports D dimer strategy

›High probability pathway supports direct imaging

›Revised Geneva score

›Objective variable scoring

›D dimer pathway when low or intermediate

›PERC rule

›Only when clinician gestalt low risk

›Requires all criteria negative to avoid D dimer

›YEARS algorithm

›Integrates clinical items with variable D dimer thresholds

›Pregnancy adapted variants local protocol dependent

›PESI and sPESI

›Risk stratifies mortality for disposition planning

›Not a rule out test

MRI

›MRI pulmonary angiography

›Limited availability and variable accuracy

›Consider when iodinated contrast contraindicated and local expertise present

›CT pulmonary angiography

›First line imaging for most nonpregnant adults

›Evaluate alternative diagnoses

›Contrast and radiation cautions

›Severe renal impairment risk discussion

›Anaphylactoid reaction history and premedication protocols local

13Special Tests/spec10

Bedside echocardiography and strain assessment

›Echocardiography

›RV dilation

›RV dysfunction

›Septal flattening

Gas exchange testing

›Arterial blood gas in selected cases

›Severe hypoxemia evaluation

›Hypercapnia suggests alternate diagnosis or fatigue

Thrombophilia testing cautions

›Thrombophilia testing

›Not for acute ED decision making

›Defer to outpatient hematology when indicated

14ECG/ecg14

PE associated ECG patterns and alternate diagnoses

›Common ECG findings

›Sinus tachycardia

›Nonspecific ST T changes

›RV strain patterns

›Right axis deviation

›RBBB

›T wave inversions V1 to V4

›S1Q3T3

High risk ECG triggers

›Concerning patterns

›New RBBB with shock physiology

›Ischemic changes suggesting ACS

Serial ECG logic

›Serial ECG

›Persistent chest pain or evolving symptoms

›Troponin positive pathway

15Assessment/ax16

Working diagnosis and pretest probability

›Suspected pulmonary embolism (I26.99)

›Pretest probability category

›Rule out pathway eligibility

Severity stratification

›Hemodynamic classification

›Massive PE

›Submassive PE

›Low risk PE

›RV strain evidence

›Troponin elevation

›BNP elevation

›Echo RV dysfunction

Diagnostic uncertainty and alternatives

›Competing diagnoses

›Pneumonia

›ACS

›Heart failure

›Pneumothorax

16Plan/plan43

Differential Management

›!Pulmonary embolism→›!Acute coronary syndrome (NSTEMI)→›Spontaneous pneumothorax→

Approach to critical patient

›First 5 minutes workflow

›Continuous monitoring

›Two large bore IV access

›Oxygen to target SpO2 at least 92 percent

›If shock, vasopressor support

›Early bedside echo when unstable

Diagnostic sequencing

›Testing pathway

›If low risk and PERC negative, no further PE testing

›If low or intermediate risk, D dimer strategy

›If D dimer positive, imaging

›If high risk, direct imaging

Anticoagulation and reperfusion

›Anticoagulation initiation

›If high suspicion and imaging delayed with acceptable bleeding risk, initiate anticoagulation

›If active bleeding or major contraindication, hold anticoagulation and escalate for alternatives

›UFH infusion when high risk or procedures anticipated

›Bolus dosing local protocol dependent

›Infusion titration to aPTT or anti Xa target local protocol dependent

›LMWH example dosing when appropriate

›Enoxaparin 1 mg per kg subcut every 12 hours

›Avoid in severe renal impairment without adjustment

›DOAC initiation when appropriate and stable

17Disposition/dispo21

ICU and high acuity criteria

›ICU level care

›Persistent hypotension

›Vasopressor requirement

›Need for thrombolysis or catheter intervention

›Severe hypoxemia requiring high level respiratory support

Inpatient admission criteria

›Admission appropriate

›RV dysfunction on echo

›Troponin or BNP elevated with PE

›PESI high risk or sPESI at least 1

›Significant comorbid disease

Observation or outpatient pathway

›Low risk disposition tools

›sPESI 0 supports low risk selection

›Hestia criteria supports outpatient eligibility

›Discharge criteria

›Stable vitals

›Low bleeding risk

›Reliable follow up within 24 to 72 hours

›Anticoagulation access confirmed

Transfer criteria

›Transfer to higher level center

›Need for catheter directed therapy not available locally

›Need for ECMO capability in refractory shock

18Discharge Instructions/di13

Copy discharge instructions

›Patient instructions

›You were evaluated for a blood clot in the lung called a pulmonary embolism

›Your risk level today is low and you are safe to go home with close follow up

›Take your blood thinner exactly as prescribed

›Do not miss doses

›Avoid NSAIDs unless your clinician says they are safe with your blood thinner

›Seek urgent care for bleeding that does not stop

›Return to the ED now for worsening shortness of breath

›Return to the ED now for chest pain

›Return to the ED now for fainting

›Return to the ED now for coughing up blood

›Follow up with your clinician within 24 to 72 hours

›Discuss how long you need to be on the blood thinner at follow up

19References/r18

Guidelines and decision tools

›European Society of Cardiology guideline for acute pulmonary embolism 2019

›Risk stratification and management pathways

›Imaging and anticoagulation recommendations

›CHEST guideline and expert panel report antithrombotic therapy for VTE disease 2021

›DOAC first line for many patients

›Duration of therapy framework

›American Society of Hematology guideline for management of VTE 2018

›Anticoagulation selection and duration concepts

›Thrombolysis and IVC filter considerations

›ACEP clinical policy suspected acute venous thromboembolic disease 2018

›PERC and D dimer strategy context

›Imaging decision support

›YEARS diagnostic algorithm studies 2017 and later validations

›Variable D dimer threshold strategy

›Reduced imaging in selected cohorts

›PESI and simplified PESI validation studies

›Mortality risk stratification

›Outpatient selection support

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.