Pulmonary embolism (PE) is a potentially life-threatening disease, which presents with non-specific signs and symptoms. Evidence suggests that diagnosis is often made on post-mortem examination and misdiagnosis is likely. There are a number of pathophysiological processes that occur in acute PE, which have several systemic effects on the body and the compensatory mechanisms. A thorough understanding of these physiological processes and how these manifest, will afford the attending clinician a greater knowledge base on which to develop clinical reasoning skills, therefore initiating timely management and transportation to definitive care. Clinicians should also have an awareness of adjunctive therapies available in the management of PE, which include inotropic support for profound shock and thrombolytic therapy in cardiac arrest. This article explores the pathophysiology of the disease process, the identification and pre-hospital management of PE.

Mark Hodkinson - Specialist Paramedic, Critical Care, South Western Ambulance Service NHS Foundation Trust

Devon Air Ambulance - Exeter Airbase, Exeter