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

**1. Initial Triage in Primary Care** - [describe the assessment of the patient with a suggestive history for PE, including actions taken or observations made during this assessment] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document the calculated PERC score and NEWS2 score, including the scores themselves] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) **2. Action based on PERC Score** - "**PERC score = 0:**" - [document the conclusion that PE is unlikely based on the PERC score] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document the decision to cease PE workup] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document any alternative diagnoses considered] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - "**PERC score >0 (or clinical suspicion of PE):**" - [document the decision to proceed to disposition based on the NEWS2 score] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) **3. Disposition based on NEWS2 Score** - "**NEWS2 score 0-4:**" - [document the advice given to the patient regarding attending A&E or SDEC] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document the patient's arrangement for their own transport] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - "**NEWS2 score -**A single red score (indicating a 3 in one parameter) is a significant warning" - [document the referral to Acute Medical Unit (AMU) via Category 3 ambulance] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - "**NEWS2 score 5-6:**" - [document the referral to AMU via Category 2 ambulance] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - "**NEWS2 score ≥ 7:**" - [document the referral to ED Resus via Category 1 ambulance] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) **4. Secondary Care Assessment (A&E / SDEC)** - [document the reassessment of the NEWS2 score, including the updated score] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document the investigations performed, including ECG and Chest X-ray results or findings] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document the calculation of pre-test probability using Wells' PE score, including the score itself] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - "**Low Probability (Wells' Score):**" - [document the D-dimer check and its results] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - "**Moderate/High Probability (Wells' Score):**" - [document the decision to proceed directly to imaging] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) **5. Imaging Modality (Secondary Care)** - "**V/Q Scan (First-line if criteria met):**" - [document if the patient's age is less than 55] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document if the patient is female] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document if there is no suspicion of pathology other than PE] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document if the chest X-ray is clear] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document if the patient is cooperative and stable] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - "**CTPA (+/- Echocardiogram):**" - [document the circumstances under which CTPA was used, specifically if V/Q scan criteria were not met] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document if CTPA is indicated due to uncooperative patients (e.g., due to hypoxia, hypotension) or with an abnormal bedside echo] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) - [document the use of echo to assess for right heart strain (RV/LV ratio), including any findings] (Only include if explicitly mentioned in transcript or context, else omit section entirely. Write as a bulleted list.) (Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care - use only the transcript, contextual notes or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes or clinical note, you must not state the information has not been explicitly mentioned in your output, just leave the relevant placeholder or omit the placeholder completely.) (Use as many lines, paragraphs or bullet points, depending on the format, as needed to capture all the relevant information from the transcript.)