PERC and WELLS negative massive PE

[EMEDPA]

a 22 yr old who is tachycardic and tachypneic with chest pain will almost always get a dimer from me in the ER unless she has trauma/burns/shingles/etc. I don't know them so don't know if they are anxious because they can't breathe or anxious and having a panic attack. getting the dimer costs me nothing.

tachycardia only in wells:

1.5 points

Low risk group: 1.3% chance of PE in an ED population.

Another study assigned scores ≤ 4 as “PE Unlikely” and had a 3% incidence of PE.

 

tachycardia only in Geneva:

5 points

Moderate risk group: ~20-30% incidence of PE from several studies.

 

all of these ocp young females with tachycardia/tachypnea as you say are perc + and I don't want to be the guy who sent home a "classic presentation for PE" (as confirmed by the 3 well known ER docs they will get to testify against you). they almost all get dimers and when they are negative they go home. anything less in patients you don't know well and you are sending home folks with PEs every now and then. If you are the pcp and have known them their whole lives that is another story. I've seen lots of PEs over the years and some of them looked like panic attacks, others looked like pneumonia/tb, and others looked like ACS. If I can talk to the obviously anxious female who just broke up with her boyfriend and get her to chill without meds so her tachycardia and tachypnea resolve, I may not go through the workup. the rest of them get the full meal deal.