What symptoms (2) and signs (4) might suggest acute pulmonary embolism as the cause of this acute event?

  • 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 Max 2
  • Pleuritic chest pain 1
  • Dyspnea 1
  • Hemoptysis 1
Signs Max 4
  • Acute onset of tachypnea 1
  • Hypoxia or increased oxygen requirements 1
  • Tachycardia 1
  • Hypotension
  • Unexplained agitation 1
  • Asymmetric leg swelling 1
  • Weaning failure
  • Persistent pyrexia without evident source of infection
  • Cardiovascular and respiratory examination findings:
    • Pleural friction rub 1
    • Small volume arterial pulse
    • Raised jugular venous pressure 1
    • Gallop rhythm at the left sternal edge 1
    • Accentuated second heart sound 1