24 Questions
What is the primary concern for the 55-year-old man aside from his obesity?
Pulmonary embolism
What is a potential risk factor for the 55-year-old man's symptoms?
Obesity
What is the significance of the normal ECG result in the 55-year-old man?
It rules out cardiac arrhythmia as a cause of his symptoms
What is the significance of the 65-year-old woman's recent COVID-19 diagnosis?
It increases her risk of developing pulmonary embolism
What is the significance of the 65-year-old woman's clear lung examination?
It suggests that her symptoms are not due to a respiratory condition
What is the primary concern for the 65-year-old woman aside from her recent COVID-19 diagnosis?
Pulmonary embolism
What is a potential complication of pulmonary embolism?
Mortality
What is the significance of the 55-year-old man's normal natriuretic peptide result?
It indicates that he is at low risk of cardiac disease
What is the primary goal of this educational activity for emergency medicine physicians?
To identify areas in practice that require modification to be consistent with current evidence
What is a key aspect of the CME objectives related to pulmonary embolism?
Identifying the risks of pulmonary embolism based on a patient's clinical presentation
What is the target audience for this educational activity?
Emergency medicine physicians, physician assistants, nurse practitioners, and residents
What is a contributing factor in determining the need for this educational activity?
All of the above
What is a key aspect of the management approach for pulmonary embolism?
Developing a management approach based on the clinical and diagnostic characteristics of the patient
What is a topic that may be discussed during the educational activity?
Investigational information about pharmaceutical products that is outside FDA-approved labeling
What is the total number of enduring material AAFP Prescribed credits approved for this educational activity?
4.0
What is the purpose of the needs assessment in this educational activity?
To determine the need for the educational activity
What is a significant risk factor for the patient's pulmonary embolism?
Recent hospitalization for COVID-19
What is the most likely reason for the patient's recent discontinuation of low-molecular-weight heparin (LMWH)?
Recent hospital discharge
What is the most significant finding in the patient's initial presentation?
Cyanosis
What is the most appropriate next step in the patient's management?
Administer oxygen and prepare for further evaluation
What is the significance of the patient's recent hospitalization for COVID-19?
It increases the risk of pulmonary embolism
What is a common feature of patients with pulmonary embolism?
Variable clinical presentations
What is the significance of the patient's D-dimer result?
It is a sensitive but not specific test for pulmonary embolism
What is a potential outcome of patients with pulmonary embolism, despite aggressive care?
Some patients may die despite aggressive care
Study Notes
Case Presentations
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A 55-year-old obese man reports exertional dyspnea, with a normal ECG, and normal chest x-ray, natriuretic peptide, and high-sensitivity troponin results.
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The patient's symptoms can be explained by his weight, but the doctor wonders if they should start a diagnostic pulmonary embolism algorithm.
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A 65-year-old woman presents with shortness of breath, with a recent history of COVID-19 disease, and a well-documented IV contrast allergy.
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Her D-dimer results are incalculably high, and a pulmonary perfusion scan shows a clear perfusion defect consistent with a pulmonary embolism.
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A 60-year-old woman presents in extremis with severe shortness of breath, having recently stopped low-molecular-weight heparin (LMWH) 4 days prior.
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She is cyanotic, tachypneic, tachycardic, and has a pulse oximetry of 70%, with a sinus tachycardia of 130 beats/min and a blood pressure of 84/40 mm Hg.
Pulmonary Embolism
- The presentation of patients with pulmonary emboli can range from obvious to extremely subtle.
- Clinical outcomes may seem to defy any physiologic management, with patients with massive clot burden surviving with minimal interventions, while others with relatively minor emboli may die despite aggressive care.
CME Objectives
- Identify the risks of a pulmonary embolism based on a patient's clinical presentation.
- Select appropriate diagnostic studies to identify the presence of a pulmonary embolism.
- Select appropriate diagnostic studies to determine the severity of the patient's condition.
- Develop a management approach based on the clinical and diagnostic characteristics of the patient.
This medical publication provides a general guide and is not intended for making specific medical decisions. It is a highly technical and complex subject and should not be used to establish policy, procedure, or standard of care.
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