Pulmonary embolism physical examination

Associate Editors-in-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
The decision to do medical imaging is usually based on clinical grounds, i.e. the medical history, symptoms and findings on physical examination, followed by an assessment of clinical probability.

Vital Signs
Patient may have:
 * Tachypnea
 * Lowered SpO2 level on room air.

Without immediate intervention it might lead to shock or even collapse. About 15% of all cases of sudden death are attributable to PE.

Patients with Submassive PE present with signs of RV dysfunctions, which are as follows: However, these signs have poor sensitivity.
 * Distended neck veins.
 * Parasternal heave.
 * Prominent second heart sound (P2).
 * Murmur of tricuspid regurgitation.

Appearance of the Patient
The patient may appear anxious because of difficulty in breathing. More severe cases may be associated with cyanosis (bluish discoloration, usually of lips and fingers).

Thorough assessment should be made for the presence of a deep vein thrombosis.