Rosh Review MyEMCert Question

A 46-year-old woman with a history of borderline high cholesterol levels presents with acute-onset chest pain 2 days ago with progressively worsening shortness of breath. Her only medication is an oral contraceptive pill that she has taken for over 20 years. Vital signs show HR of 121 bpm, BP of 124/80 mm Hg, RR of 24/min, T of 37.2°C, and SpO2 of 93% on room air. Her ECG shows sinus tachycardia. CTA of the chest shows a segmental pulmonary embolism. What is this patient’s risk of morbidity and mortality based on the pulmonary embolism severity index?

1. High
2. Intermediate
3. Low
4. Very high
5. Very low

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References

1. Kabrhel C. Pulmonary embolism and deep vein thrombosis. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Elsevier; 2023:(Ch) 74.
2. Roy PM, Penaloza A, Hugli O, et al. Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial. Eur Heart J. 2021;42(33):3146–3157.
3. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021;160(6):e545–e608.
4. Yoo HHB, Nunes-Nogueira VS, Fortes Villas Boas PJ, Broderick C. Outpatient versus inpatient treatment for acute pulmonary embolism. Cochrane Database Syst Rev. 2022;2022(5):CD010019.

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter/X: @srrezaie)