What are the clinical features that may suggest pulmonary embolism as a cause of a patients deterioration?

  • Clinical features are non-specific and have been shown to be of limited value in confirming the diagnosis
  • Features range from being relatively asymptomatic to significant cardiovascular compromise – they can be difficult to identify in the sedated, mechanically-ventilated patient
  • Haemodynamic instability is a rare but important form of clinical presentation, as it indicates central or extensive PE with severely reduced haemodynamic reserve
  • Common features include:
Symptoms
  • Pleuritic chest pain
  • Dyspnea
  • Hemoptysis
Signs
  • Acute onset of tachypnea
  • Hypoxia or increased oxygen requirements
  • Tachycardia
  • Hypotension
  • Unexplained agitation
  • Asymmetric leg swelling
  • Weaning failure
  • Persistent pyrexia without evident source of infection
  • Cardiovascular and respiratory examination findings:
    • Pleural friction rub
    • Small volume arterial pulse
    • Raised jugular venous pressure
    • Gallop rhythm at the left sternal edge
    • Accentuated second heart sound