The following signs and symptoms may be present in a patient with pulmonary embolism

1.      Sudden onset dyspnea - over minutes to hours and in approx occurs over days (most common)

2.      Pleuritic chest pain

3.      Cough

4.      Leg swelling or pain

5.      Hemoptysis

6.      Unexplained tachypnea with RR > 20/min is found in approx 70%

7.      Rales on chest auscultation

8.      Tachycardia

9.      Increased pulmonic component of second heart sound

10.  Fever

·       Classify risk using Well’s clinical prediction score

·       Use the following diagrams for further evaluation

·       Treatment of hemodynamically stable patients

o   For those in whom risk of bleeding is low, anticoagulant therapy is indicated

o   For those with contraindications to anticoagulation or those with high risk of bleeding placement of Inferior vena cava filter is indicated

o   Thrombolytic therapy is not recommended

·       Treatment of hemodynamically unstable patients

o   Thrombolytic therapy is indicated in most patients, provided there is no contraindication

o   Embolectomy is appropriate in whom thrombolysis is not possible or failed

·       Initial anticoagulation

o   To be administered as soon as possible to quickly achieve therapeutic anticoagulation

·       Long term anticoagulation

o   All patients are anticoagulated for a minimum of 3 months