Pulmonary embolism is an uncommon cause of syncope among patients presenting to the ED.

The Pregnancy-Adapted YEARS Algorithm safely and accurately ruled out pulmonary embolism (PE) for pregnant patients and reduced the rate of CT pulmonary angiography (CTPA) across all trimesters.

There was no statistical difference in inadequate vascular filling for CT pulmonary angiogram (CTPA) if the IV catheter was smaller than 20 gauge (ga) or if it was not in the antecubital fossa (AC) or forearm. Read on for the caveats.

Using a diagnostic algorithm of revised Geneva, D-dimer, leg ultrasound, CTPA (and V/Q if inconclusive) safely ruled out PE in pregnant women.

Simplified PESI (sPESI) and Hestia scores identified similar numbers of patients with pulmonary embolism as low risk. Both groups had similar 30-day all-cause mortality. However, interobserver reliability was better with sPESI.

A protocol in select ED patients with low PESI, no RV dysfunction on echo, and no proximal DVT was safe for treating PE as an outpatient.

In this retrospective review, age-adjusted, clinical probability-adjusted, and standard D-dimer approaches had similar NPVs (99.7%, 99.1%, 100% respectively). Clinical probability-adjusted D-dimer has potential to exclude PE in more patients without imaging, but use caution before applying this to practice until prospectively validated.

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Transfeminine patients had nearly doubled risk for venous thromboembolism (VTE).  The risk tripled for VTE and doubled for stroke if taking hormone supplementation.

For patients with high pretest probability for pulmonary embolism, a negative CT pulmonary angiography alone does not appear to adequately rule out venous thromboembolism.