This early study of thrombolytics plus heparin for submassive PE showed no mortality benefit but did show a decrease in need for escalation of care compared with heparin alone.  Subsequent studies call lytics for submassive PE into question, so take the current evidence into account.

The PERC rule is a powerful diagnostic tool.  If you determine a patient has low clinical gestalt for PE and all 8 PERC criteria are negative, then PE has been ruled out without checking a D-dimer or CT.

Patients with a "PE likely" pretest probability may be considered ruled out for PE after negative CTPA with no additional testing, assuming the same (or lower) prevalence of PE in your setting.

This simplified protocol worked well, was safe, and provided a one-size-fits-all approach to the workup of VTE.  It also reduced CT use by 14%.

Bedside echo that answers a specific question, in this case - is the RV dilated or not - may be reliably performed, even by novice sonographers in the ED.

It looks like we can start thinking of the D-dimer test based on interval likelihood ratios rather than a dichotomous positive or negative, with 500 ng/mL as the cutoff.

Thrombolytic therapy for submassive PE didn't change the incidence of chronic thromboembolic pulmonary hypertension.

The simplified Wells score for PE vs. original Wells, both with an age-adjusted D-dimer, were equal to exclude PE.

Managing PE as an outpatient may not only be safe, it may be safer than hospitalization.

PE may cause chronic dyspnea in almost half of affected patients.