In anticipation of Episode 21 on Respiratory Emergencies, Dr. John Foote the CCFP(EM) residency program director at the University of Toronto presents his Best Case Ever related to the dyspeic patient.

In the upcoming episde, Dr. Foote and Dr. Anil Chopra, the author of past Tintinalli chapters on thromboembolic and arterial disease discuss how to approach the patient with dyspnea and the pearls and controversies of pulmonary embolism. They discuss how best to develop a clinical pre-test probability for the diagnosis of pulmonary embolism using risk factors, some new evidence about the PERC rule, Well’s criteria and how clinical gestalt plays into pre-test probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation, and how it can be used in pregnancy and in the elderly. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controvesies around thrombolysis for submassive PE are reviewed.