Emergency department management of pulmonary embolism

There are several points that bear repetition. First, consider the diagnosis of PE in all patients presenting with chest pain, dyspnea, syncope, oxygen desaturation, or unexplained hypotension. Evaluate these patients in a rational manner. At any individual hospital, develop algorithms with consultants so that when one is faced with a patient with a PE, the flow of both diagnostics and therapeutics flows smoothly and rapidly. Consider the concept of risk stratification, and remember that not all patients with PE are created equal. In particular, be on the same page with all consultants regarding the use of right heart echocardiography, both for its potential diagnostic capabilities and for its ability to identify patients who could be at greater risk for bad outcomes.