Welcome to the Emergency Medicine Cases podcast with your host, Dr. Anton Hellman,

bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

Even the greenest trainees rotating through the ED can name a few deadly causes of chest pain.

But for all the cognitive space they occupy, we see them and work them up relatively infrequently.

Borreaves?

Not your standard once a week presentation.

Stemmy?

In some tertiary centers, they bypass EDs altogether.

Tension Numo?

Not exactly a row of folks sitting patiently in the waiting room each shift.

But what about the chest pain and shortness of breath chameleon pulmonary embolism?

More common, sometimes just as deadly, and exceptionally shifty.

If I were to design a perfect emergency medicine brain buster, it would have all the qualities of pulmonary embolism.

It would affect the young and the old.

It would be precipitated by seemingly anything, medications, smoking, and even video gaming.

It would be dynamic, anything from asymptomatic to killing in minutes.

It would have a huge variability in presenting signs and symptoms depending on a whole host of patient factors.

It would have multiple decision rules, imaging modalities, and treatment options.

It's as if PE was invented just to challenge the minds of EB docs. So here's the big question.

Which patients require a workup for PE? And if they do require a workup, what's the best way to work them up?

What we really want are decision aids that maximize diagnostic accuracy while minimizing

overtesting and patient harm resulting from overtesting, overdiagnosis, and anticoagulation

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