Criteria for the recognition of pulmonary emboli.

EFFECTIVE therapy can reduce to a fraction the risk of recurrent pulmonary emboli. However, failure to recognize the disorder continues to be one of the major causes of disability and death. An organized approach to the assessment of the patient with suspected recent pulmonary embolus is as important as any individual test. One of the first decisions is when to initiate therapy. This decision will have to be made on the clinical estimation of how likely the possibility is that the patient has had an embolus. If the clinical picture is typical or even highly suspicious, intravenous heparin therapy should be initiated immediately. On the other hand, if pulmonary embolization seems unlikely and is being considered only as an outside possibility, it is prudent to withhold treatment and gather further evidence as expediently as possible. Clinical Presentation A careful search of the history for suggestive symptoms, often nonspecific and subtle,