Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman, bringing you the brightest minds in emergency medicine from around the world.

EMCases is brought to you by Shremi, the Schwartz-Riesman Emergency Medicine Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from a qualified practicing physician.

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slash EMC-A-S-E-S. In EM, there's a whole lot of attention paid to the diagnosis of pulmonary embolism.

We've done multiple podcasts on when to suspect PE and how to work it up.

But once we've made the diagnosis, our job is not done.

We need to know how to rest stratify these patients and how to manage them so they don't go down that dreaded RV failure spiral of death thing.

So here's the problem.

The optimal approach to risk stratification and management of the intermediate risk, pulmonary embolism patient, is not known.

So those are the ones who aren't in shock, but aren't well

enough to go home on an oral anticoagulant. Intermediate risk pulmonary embolism patients, this middle

group, as you'll hear, is a highly heterogeneous group with some of these patients just needing

an oral anticoagulant or low molecular rate heparin

and others requiring lytics or an epilectomy.

So why is this a problem?

Well, it's partly because the evidence for various treatments is not robust enough yet.

It's also, at least in part because it's unclear how to risk stratify these patients.

The various risk scores aren't that great for this

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