Respiratory
Pulmonary embolism
Match the next test and treatment to probability and to whether the circulation is failing.
Educational only. A local note appears only when a public source is attached. This page does not say that one exam, or training in one country, makes you eligible to practice in another.
Global core
Venous clot can travel to the lung. A stable patient is assessed with pretest probability, then a D-dimer or definitive imaging. An unstable patient is resuscitated first. Anticoagulation is the usual treatment when bleeding risk allows. Thrombolysis is for life-threatening instability, not for every clot.
What stays the same
- A stable, high-probability embolism is not discharged on a D-dimer.
- Thrombolysis is for life-threatening instability, not for every clot.
- Anticoagulation is usual when bleeding risk allows. The agent is local.
- Recognize. Sudden breathlessness, pleuritic pain, hemoptysis, or a swollen leg.
- Reason. Probability decides whether a negative D-dimer is enough or whether imaging is required.
- Prioritize. Hypotension and right-heart strain are the emergency. A small clot in a stable person is not.
- Act safely. Support the circulation if it is failing. Anticoagulate when it is safe. Do not thrombolyse a stable patient by habit.
Local adaptation
No sourced local note is attached to this topic. That is not a statement that every country manages it the same way. The shared principle above is what this beta is willing to teach.
Exam lens
The next test, chosen from probability and stability.
Original case · shared decision
The lens above is how that exam usually frames the medicine. This case stays on the shared decision. Not an official examination item.
A 44-year-old woman has sudden breathlessness three days after pelvic surgery. Blood pressure is 128/76 mm Hg, heart rate is 108/min, and oxygen saturation is 93% on air. One calf is swollen. She has no bleeding. What is the most appropriate next step?