Suspected Pulmonary Embolism (PE) Management Protocol - Primary Care Pathway (Based on GIRFT Guidelines)

**1. Initial Triage in Primary Care** - Patient presented with sudden onset of shortness of breath and chest pain. Oxygen saturation was 94% on room air. Patient denies any recent travel or surgery. (Patient is a smoker). - PERC score = 0, NEWS2 score = 2. **2. Action based on PERC Score** - **PERC score = 0:** - PE is unlikely based on the PERC score. - Cease PE workup. - Alternative diagnoses considered: Asthma exacerbation, anxiety. - **PERC score >0 (or clinical suspicion of PE):** - Proceed to disposition based on the NEWS2 score. **3. Disposition based on NEWS2 Score** - **NEWS2 score 0-4:** - Advised patient to attend A&E. Patient to arrange own transport. - **NEWS2 score -**A single red score (indicating a 3 in one parameter) is a significant warning - Patient was referred to Acute Medical Unit (AMU) via Category 3 ambulance. - **NEWS2 score 5-6:** - Referred to AMU via Category 2 ambulance. - **NEWS2 score ≥ 7:** - Referred to ED Resus via Category 1 ambulance. **4. Secondary Care Assessment (A&E / SDEC)** - Reassessment of NEWS2 score: 3. - Investigations performed: ECG showed sinus rhythm. Chest X-ray showed no acute findings. - Wells' PE score calculated: 3 (Moderate Probability). - **Low Probability (Wells' Score):** - D-dimer check performed: Result pending. - **Moderate/High Probability (Wells' Score):** - Proceed directly to imaging. **5. Imaging Modality (Secondary Care)** - **V/Q Scan (First-line if criteria met):** - Patient is under 55. - Patient is female. - No suspicion of pathology other than PE. - Chest X-ray is clear. - Patient is cooperative and stable. - **CTPA (+/- Echocardiogram):** - CTPA was used as V/Q scan criteria were met. - CTPA was indicated due to uncooperative patients (e.g., due to hypoxia, hypotension) or with an abnormal bedside echo. - Echo was used to assess for right heart strain (RV/LV ratio), including any findings.