PE Investigation/Management

Question 1

What criteria should you look at first when you think someone has a less than 15% chance of PE according to NICE?

Answer 1

Pulmonary Embolism Rule-out Criteria (PERC)

Question 2

What do you do if someone has any of the PERC criteria?

Answer 2

Do a 2-level wells score

Question 3

When would you start off with a 2-level wells score?

Answer 3

If pre-test probability is 15% or above (clinical judgement)

Question 4

What are the cut-offs for 2 level wells score?

Answer 4

PE unlikely - 4 or less
PE likely - 5 or more

Question 5

What should be done if someone has a 2 level wells score >4?

Answer 5

CTPA
Start DOAC if delay in getting this

Question 6

What should be done if someone has a negative CTPA?

Answer 6

Consider proximal leg vein ultrasound scan if DVT susptected

Question 7

What should be done if someone has a 2 level wells score of 4 or less?

Answer 7

D-dimer
If positive CTPA
If negative stop any anticoagulation

Question 8

What other scan should all patients with suspected PE receive?

Answer 8

Chest x-ray