Episode 214: Acute Pulmonary Embolism

Pulmonary embolism (PE) in the emergency department is examined, emphasizing risk stratification and precise resuscitation. The discussion covers the origins and incidence of PE, noting that it often presents with varied symptoms, from shortness of breath to collapse. Risk factors such as age, inherited conditions, and recent surgeries are reviewed. Diagnostic strategies include assessing pretest probability, key historical details, and the utility of labs like D-dimer, troponin, and BNP for gauging RV strain. Imaging modalities, such as CT pulmonary angiography, VQ scans, and ultrasound, are evaluated for their strengths and limitations. Initial treatment steps prioritize oxygenation and afterload reduction, with cautious fluid administration and strategic vasopressor use. The conversation also covers the use of systemic thrombolytics and catheter-directed interventions for high-risk cases, as well as disposition decisions based on risk stratification.