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Pulmonary Embolism

Dr Swapnil Pawar October 5, 2020 1060 5

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Management of Pulmonary Embolism

Written by – Dr Andrew Lam

Well’s Criteria for PE

Clinical Signs and Symptoms of DVT3
PE is No. 1 Diagnosis or Equally Likely3
Heart Rate >100 BPM1.5
Immobilisation for 3+ Days or Surgery in Last 4 Weeks1.5
Previous PE or DVT1.5
Malignancy with Treatment Within 6 months or Palliative1

Pulmonary Embolism Rule Out Criteria (PERC)

Age > 501
Heart Rate >100 BPM1
SpO2 on Room Air <95%1
Unilateral Leg Swelling1
Recent Surgery or Trauma1
Previous PE or DVT1
Hormone Use1

Low Probability of PE (Well’s Score <2) 

If PERC score is 0, then pulmonary embolism can be clinically ruled out
If PERC score is > 1, then D-Dimer needs to be measured

Intermediate Probability of PE (Well’s Score 2-6) 

Will require a D-Dimer

High Probability of PE (Well’s Score > 6) 

Go straight to CT Pulmonary Angiogram or V/Q Scan


If D-Dimer <500ng/ml, then PE can be excluded, no further testing required
If D-Dimer >500ng/ml, then diagnostic test must be completed (CT Pulmonary Angiogram or V/Q Scan) 

Classifications of PE’s

Massive PE – PE resulting in haemodynamic instability 

Systolic BP <90 mmHg
Drop in systolic BP > 40mmHg from baseline for >15 minutes
Hypotension requiring vasopressor or inotropic support

Submassive PE – PE not fulfilling criteria of massive PE, but with: 

Right Ventricular Dysfunction
– ECG changes (RBBB, right ventricular strain pattern, right axis deviation)
– Echocardiographic changes
Myocardial Necrosis
– Troponin Rise

Non-Massive PE – PE not fulfilling criteria for massive or submassive PE’s


Nickson, D. (2020). Pulmonary Embolism • LITFL • CCC Respiratory. Retrieved 22 September 2020, from

PERC Rule for Pulmonary Embolism – MDCalc. (2020). Retrieved 22 September 2020, from

Thompson, B.T.., & Kabrhel, C. (2020). Overview of Acute Pulmonary Embolism in Adults. UpToDate. Retrieved September 22, 2020, from

Wells’ Criteria for Pulmonary Embolism – MDCalc. (2020). Retrieved 22 September 2020, from

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