Establishing or excluding the diagnosis of PE is a challenge requiring the synthesis of clinical suspicion, awareness of predisposing risk factors, and the interpretation of diagnostic studies utilizing pretest probability of PE. While only a negative pulmonary angiogram excludes the diagnosis of PE, 10 this test is required only when sufficient doubt about the diagnosis or contraindications to empiric therapy exist. 11
Unexplained chest pain, dyspnea, or tachypnea should always raise the question of PE as the cause. If these findings occur in a patient at risk for thromboembolic disease the diagnosis of PE must be strongly considered. All patients with chest pain, dyspnea, or tachypnea not explained by the history or physical exam should undergo screening tests, including an electrocardiogram (ECG), chest x-ray (CXR), and arterial blood gas (ABG) analysis.
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