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Unfortunately, PE may be asymptomatic or present with sudden death.
Characteristic signs and symptoms such as tachycardia, dyspnea, chest pain, hypoxemia, and shock are non-specific and are present in many other conditions, such as acute MI, congestive heart failure, or pneumonia.
Failure to diagnose PE is a serious management error since 30% of untreated patients die, while only 8% succumb with effective therapy.
There are scoring systems to assist in the determination of likelihood of PE and thromboembolic events.
Diagnostic scoring systems such as the Wells criteria and Geneva score are often used [Table 3] and [Table 4].
Obstruction of the pulmonary arteries creates dead space ventilation as alveolar ventilation exceeds pulmonary capillary blood flow.
This contributes to ventilation-perfusion mismatch, with vascular occlusion of the arteries increasing pulmonary vascular resistance.
The elements of diagnostic workup will vary depending on whether the patient is hospitalized and whether there is hemodynamic instability.