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Shahzeb Hassan: Pulmonary Embolism – What to Do When Every Minute Matters
Shahzeb Hassan/LinkedIn
Apr 15, 2026, 14:13

Shahzeb Hassan: Pulmonary Embolism – What to Do When Every Minute Matters

Shahzeb Hassan, House Officer at Northwest General Hospital and Research Centre, Peshawar, shared a post on LinkedIn:

“Suppose a patient present to the ER with sudden onset shortness of breath and pleuritic chest pain.

He looks anxious. His pulse is 120, BP 90/60, oxygen saturation 88% on room air and droping.

No past cardiac history.

But digging deeper – recent long travel plus calf pain 3 days ago.

Suspect:

Pulmonary Embolism (PE);

What to do:

Step 1: Risk stratification

Start with clinical probability:

Wells score

  • 0–1 – Low probability
  • 2–6 – Moderate probability
  • Greater than or equal to 7 – High probability

If low – D-dimer

If high – skip D-dimer and go straight to imaging

Step 2: Immediate stabilization

  • Oxygen support
  • IV access plus fluids (cautiously)
  • Start anticoagulation immediately (unless contraindicated)

But here’s the key:

Hypotension is red flag – think ‘thrombolysis’

Step 3: Confirm diagnosis

  • CT Pulmonary Angiography (gold standard), if contraindicated as in Pregnancy equals V/Q test…
  • If unstable – bedside echocardiography (RV strain clues)

Step 4: Definitive management

If Massive PE (shock/hypotension)

  • Systemic thrombolysis (Alteplase)
  • If contraindicated – catheter-directed therapy / surgical embolectomy

If Submassive PE (RV strain but stable)

  • Anticoagulation
  • Consider thrombolysis selectively

If Low-risk PE

  • Anticoagulation alone (often outpatient)

Step 5: Anticoagulation strategy

Initial: LMWH / UFH / DOACs

Long-term:

  • Provoked PE – 3 months
  • Unprovoked – extended therapy
  • Recurrent – lifelong anticoagulation

Step 6: Don’t Forget the Cause

Always ask:

  • Immobilization?
  • Surgery?
  • Malignancy?
  • Thrombophilia?

Treating PE without addressing the cause equals setting up recurrence…!

Clinical Pearl

Not every PE presents dramatically.

Some patients just have:

  • Mild dyspnea
  • Unexplained tachycardia
  • Or even vague anxiety

Timely management equals good clinical outcomes…!”

Shahzeb Hassan: Pulmonary Embolism - What to Do When Every Minute Matters

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