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Pulmonary Embolism Moderate Probability EvaluationAka: PE Moderate Probability Evaluation, Moderate PE Probability, Intermediate PE Probability

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  1. See Also
    1. Pulmonary Embolism
    2. Pulmonary Embolism Diagnosis
    3. Pulmonary Embolism Low Probability Evaluation
    4. Pulmonary Embolism High Probability Evaluation
  2. Technique
    1. Based on PE Probability (See PE Diagnosis)
    2. Consider Alternative Diagnosis
      1. See Chest Pain Causes
      2. See Dyspnea Causes
      3. See Leg Pain Causes
  3. Step 1: Determine if Deep Vein Thrombosis Present
    1. No Signs and Symptoms of DVT
      1. Jump to step 2 below
    2. Signs and Symptoms of DVT
      1. Lower Extremity Doppler Ultrasound Positive for DVT
        1. Treat with Pulmonary Embolism Management
      2. Lower Extremity Doppler Ultrasound Negative for DVT
        1. Move to step 2 below
  4. Step 2: Imaging Study
    1. Ventilation Perfusion Scan (V/Q Scan)
      1. Normal Probability V/Q Scan
        1. No further evaluation needed
        2. Evaluate for alternative diagnosis
      2. Low or Intermediate Probability VQ Scan
        1. Jump to Step 3 below
      3. High Probability V/Q Scan
        1. Treat with Pulmonary Embolism Management
    2. CT Pulmonary Angiogram (Spiral or helical chest CT)
      1. Spiral Chest CT suggestive for PE (Positive)
        1. Treat with Pulmonary Embolism Management
      2. Spiral Chest CT not suggestive for PE (Negative)
        1. Jump to step 3 below
  5. Step 3: Obtain Lower Extremity Compression Ultrasound
    1. Negative compression ultrasound
      1. Obtain D-Dimer or repeat compression ultrasound
      2. Negative: Evaluate for alternative diagnosis
        1. PE in 1.8% if if CT and leg ultrasound negative
        2. Musset (2002) Lancet 360:1914
      3. Positive: Treat with Pulmonary Embolism Management
    2. Positive compression ultrasound
      1. Treat with Pulmonary Embolism Management
  6. References
    1. Ramzi (2004) Am Fam Physician 69:2829
    2. Wells (1998) Ann Intern Med 129(12):997

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