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PE Disposition Tool
Denver Health ED · PESI + RV Strain · AHA/ACC Classification
Full PESIAHA/ACC ClassesDH ED Guideline
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No Disposition Calculated Yet
Enter patient data in the left panel, then press Calculate Disposition to generate a recommendation.
📊PESI Score Calculator
PESI Score
0
Class I
Very Low · <1.6%
Class I ≤65 · II 66–85 · III 86–105 · IV 106–125 · V >125
Age (pts = age value)
yrs
Sex
Vitals
Heart Rate (+20 if >110)
bpm
SBP (+30 if <100)
mmHg
RR (+20 if >30)
/min
Temp (+20 if <36°C)
°C
SpO₂ (+20 if <90%)
%
Comorbidities
⚡Hemodynamic Status
Assessed in order — first "Yes" determines disposition pathway.
🔬RV Strain & Biomarkers
New RV Strain
CT: RV/LV >1 or IVC/hepatic reflux
POCUS: RV dilation, D-sign, McConnell sign
hs-cTroponin
High-sensitivity cardiac troponin
O₂ Requirement
L/min
≥6 LPM related to PE → MICU
O₂ Above Baseline
L
>2L above baseline → Floor; 0 → Discharge
🎯DH Disposition Algorithm
HIGH RISK E1/E2 — Cardiopulmonary failure
MICU
INT-HIGH D1/D2 — Incipient failure
MICU
INT-HIGH C3 — RV+Tn or O₂≥6/HR>120/RR>30
MICU
INT-LOW C1/C2 — RV or Tn+ with PESI>104
FLOOR
LOW RISK C1 — PESI 86–104, no RV/Tn
CDU
LOW RISK A/B1/B2 — PESI ≤85, no RV/Tn, no O₂
DISCHARGE
🔔Nurse Escalation Triggers
Notify APP/MD IMMEDIATELY if any of the following:
  • SBP <90 after 1L IVF or recurrent hypotension — call MD immediately
  • HR >120 sustained or new dysrhythmia
  • SpO₂ <92% despite ≥4L O₂ or increasing O₂ requirement
  • RR >30 or worsening work of breathing
  • New AMS, syncope, or hemoptysis
  • Any major bleeding (GI/GU/expanding hematoma)
📈Escalation & IR Rules
  • Upgrade to MICU if SBP <90 after 1L IVF or vasopressors required
  • Upgrade if new/worsening RV strain on echo or repeat hs-cTn elevation
  • Upgrade if lactate >2 after resuscitation
  • Do not delay systemic thrombolytics for IR discussion in Class E1/E2
  • IR consultation at treating provider's discretion; MICU team will consult IR if no improvement on standard therapy
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This is a disposition guideline and should not supersede the treating provider's clinical judgement. Patients may not strictly fall into triage criteria/AHA categories and warrant discussion between the ED Provider and admitting services.