Pulmonary Embolism

Question 1

If clinical suspicion for PE is LOW
Gestalt <15% or Wells score <2

Answer 1

PERC RULE

Question 2

If clinical suspicion for PE is LOW
Gestalt <15% or Wells score <2

PERC Negative

Answer 2

NO PE

Question 3

If clinical suspicion for PE is LOW
Gestalt <15% or Wells score <2

PERC POSITIVE

Answer 3

QUANTItative D-dimer

Question 4

If HIGH Suspicion of PE

PE unlikely:
Wells 2-4
SRGS (Geneva Score) 2-4

Answer 4

QUANTItative D-dimer

Question 5

If HIGH Suspicion of PE

PE likely:

High Gestalt >40%
Wells >4
SRGS (Geneva Score) >4

Answer 5

Consider LMWH

Order CREA and Imaging

Question 6

QUANTItative D-dimer

<500 FEU
nanograms/mL

or < age × 10
nanograms/mL

Answer 6

NO PE

Question 7

QUANTItative D-dimer

≥500 FEU
nanograms/mL
or ≥ age × 10
nanograms/mL

Answer 7

Order Crea and Imaging

Question 8

If Serum Cr→
GFR <60
mL/min

Answer 8

V/Q planar
or V/Q SPECT

If Homogenous perfusion (Normal): No PE
If Diagnostic (+): PE
If Non-diagnostic: do CTPA

Question 9

Serum Cr→
GFR >59
mL/min

Answer 9

CT pulmonary angiography (CTPA)

If (+): PE
If (-): Do (B) LE Compression US

Question 10

NEGATIVE
CT pulmonary angiography (CTPA)

Answer 10

Bilateral lower extremity compression US

If (+) : PE
Of (-) : No PE