USMLE/COMLEX - Step 2 - Pulmonary Embolism

USMLE/COMLEX - Step 2 - Pulmonary Embolism Mnemonic “SHE” Stasis (obesity, immobility, CHF) Hypercoagulability (severe burns, malignancy, pregnancy, postpartum, OCP or cigarette use, coagulation disorder) Endothelial Injury (trauma, recent fracture, surgery, previous DVT) Sudden onset or subacute dyspnea Pleuritic chest pain Cough Tachypnea Tachycardia Hypotension JVD New-onset right bundle brand block Calculate Wells score Wells score < 4: D-dimer to exclude PE If normal, exclude PE If D-dimer is > 500 ng/mL: V/Q or chest CT with contrast Wells score > 4: Chest CT with contrast Acute: unfractionated heparin, low molecular weight heparin, fondaparinux, rivaroxaban, or apixaban Chronic: LMWH, rivaroxaban, apixaban, or warfarin LMWH used in pregnancy or when warfarin is contraindicated