Impact of the beginning of COVID 19 pandemic on prehospital emergency medical service utilization

Patients seek emergency medical service (EMS) help for non-urgent conditions every day. The aim of this study was to analyze the impact of the first 28 days of the COVID-19 pandemic in Croatia on prehospital EMS utilization. A retrospective observational cohort study of all patients attended by EMS teams of Sveti Ivan Zelina, Croatia, in the period from March 11 through April 8, and for every year between 2015 and 2020. The data from the mentioned period for 2020 was also compared with the 8 weeks earlier period (December 18, 2019, through January 15, 2020). Data was collected from eHitna software, and the main measure of outcome was determined by the International Classification of Disease (ICD-10) diagnostic code, assigned by the attending physician. During the study period, we observed 1171 walk-in patients and 750 on field interventions. There was a decrease of 41% in walk-in cases during the pandemic from an average of 209 (± 36.89) cases between 2015 and 2019 to 123 walk-in cases in 2020. Also, there was a significant increase in the proportion of cases involving injuries by 11% (p = 0.01) and mental health issues by 5% (p ˂ 0.01). Considering that there were 41% more walk-in visits in the pre-pandemic period, we conclude that EMS is used in large numbers for non-emergency conditions

Dijagnostika plućne embolije u Objedinjenom hitnom bolničkom prijamu

The aim of this study was to determine the association of clinical presentation, the Wells scoring system and D-dimer values with MSCT pulmonary angiography. A case control study was conducted in the Emergency Department of the Clinical Hospital Sveti Duh throughout 2019. Patients with a referral diagnosis of a pulmonary embolism were included in the study. Patients were divided into two groups. The first group consisted of patients diagnosed with pulmonary embolism by MSCT pulmonary angiography or postmortem, and the second group consisted of patients excluded from pulmonary embolisms. For the Wells score, D-dimers, troponin, respiratory rate and peripheral blood oxygen saturation, statistically significant differences were found between groups of patients with confirmed or excluded pulmonary embolism (p <0.001). For heart rate, chest pain, syncope, and hemoptysis, no statistically significant differences were found between these two groups of patients. Deep venous thrombosis of the lower extremities was found by ultrasound in > 70% of patients with massive a pulmonary embolism. Pulmonary embolism was confirmed in all patients for whom a high risk was calculated according to the Wells score. In conclusion, a low degree of clinical probability (according to the Wells score), along with a normal concentration of D-dimer, are a sure strategy in excluding pulmonary embolism.Cilj rada je bio utvrditi povezanost kliničke slike, Wellsovog bodovnog sustava i vrijednosti D-dimera s MSCT plućnom angiografijom. Provedena je studija istraživanja parova u Objedinjenom hitnom bolničkom prijamu Kliničke bolnice „Sveti Duh“ tijekom cijele 2019. godine. U istraživanje su bili uključeni bolesnici sa uputnom dijagnozom plućne embolije. Bolesnici su podijeljeni u dvije skupine. U prvoj su skupini bili bolesnici kojima je dijagnoza plućne embolije potvrđena MSCT plućnom angiografijom ili post mortem, a drugu skupinu su činili bolesnici kod kojih je isključena plućna embolija. Za Wellsov skor, D-dimere, troponin, frekvenciju disanja i perifernu zasićenost krvi kisikom nađene su statistički značajne razlike između skupina bolesnika s potvrđenom, odnosno isključenom plućnom embolijom (p<0,001). Za frekvenciju srca, bol u prsima, sinkopu i hemoptizu nije nađena statistički značajna razlika između ove dvije skupine bolesnika. U >70% bolesnika s masivnom plućnom embolijom ultrazvučno je nađena duboka venska tromboza donjih ekstremiteta. Kod svih bolesnika kojima je prema Wellsovom bodovnom skoru izračunat visok rizik potvrđena je plućna embolija. Zaključno, niski stupanj kliničke vjerojatnosti (prema Wellsovom bodovnom skoru) zajedno s normalnom koncentracijom D-dimera sigurna su strategija u isključenju plućne embolije

Dijagnostička vrijednost ultrazvuka srca u procjeni trajanja arterijske hipertenzije

The aim of the study was to assess the correlation between the degree and duration of arterial hypertension and the hypertrophy of the left ventricle and the ejection fraction of the heart, with cardiac ultrasound. Our prospective study included 50 patients with arterial hypertension as leading diagnosis. All 50 patients were consecutively examined in the Emergency Department and then referred to the Cardiac clinic of the Clinical Hospital “Sveti Duh” for further evaluation. The inclusion criteria were male and female aged 18 and older and arterial hypertension as leading diagnosis during Emergency Department visit. Exclusion criteria were pathological conditions that alter myocardial architecture and impair contractility. Measurement of the left ventricle thickness based on the thickness of the intraventricular septum and the posterior wall of the left ventricle, and the ejection fraction was ultrasonically determined. The highest proportion of subjects was with the first degree of arterial hypertension, followed by subjects with a third degree. The average duration of arterial hypertension was 6.14 years. Of the total number of subjects, 28% did not take any antihypertensive drugs. A statistically significant association was found between the degree and duration of arterial hypertension with the development of left ventricular hypertrophy. Significant association wasn’t found between the degree or duration of arterial hypertension and the heart ejection fraction. Our study have shown strong correlation between the degree and duration of arterial hypertension and the development of left ventricular hypertrophy and ultrasound could be a useful method in the evaluation of some patients with arterial hypertension in the emergency department.Cilj istraživanja je bio uz pomoć ultrazvuka srca procijeniti povezanosti između stupnja i duljine trajanja arterijske hipertenzije te razvoja hipertrofije lijeve klijetke i istisne frakcije srca. Provedeno je prospektivno istraživanje koje je uključivalo 50 bolesnika sa arterijskom hipertenzijom kao vodećom dijagnozom. Svih 50 bolesnika je uzastopno pregledano u Objedinjenom hitnom bolničkom prijamu, a nakon toga upućeno u kardiološku ambulantu Kliničke bolnice „Sveti Duh“ na daljnju obradu. U istraživanje su bili uključeni bolesnici stariji od 18 godina, oba spola, s vodećom dijagnozom arterijske hipertenzije postavljene u Objedinjenom hitnom bolničkom prijamu dok su iz istraživanja bili isključeni bolesnici s patološkim stanjima koja mijenjaju arhitekturu i narušavaju kontraktilnost srca. Ultrazvučno se određivala debljina stijenke lijeve klijetke sačinjena od debljine intraventrikularnog septuma i stražnje stijenke lijeve klijetke te istisna frakcija. Najveći udio ispitanika bio je s prvim stupnjem, a slijedili su ih ispitanici s trećim stupnjem arterijske hipertenzije. Prosječno trajanje arterijske hipertenzije iznosilo je 6.14 godina. Od ukupnog broja ispitanika, 28% nije uzimalo nikakve antihipertenzivne lijekove. Pronađena je statistički značajna povezanost između stupnja i duljine trajanja arterijske hipertenzije s razvojem hipertrofije lijeve klijetke. Nije pronađena značajna povezanost stupnja niti duljine trajanja arterijske hipertenzije s istisnom frakcijom srca. Naša studija pokazala je snažnu povezanost između stupnja i duljine trajanja arterijske hipertenzije i razvoja hipertrofije lijeve klijetke, a ultrazvuk bi mogao biti korisna metoda u procjeni nekih bolesnika s arterijskom hipertenzijom u hitnoj službi

INTRAVENOUS ADMINISTRATION OF CRUSHED METHADONE AND LUNG DISEASE

Ovisnost o drogama je čimbenik rizika za nastanak brojnih akutnih i kroničnih komplikacija pluća koje se mogu razviti zbog lošeg općeg zdravlja ovisnika, ali i zbog izravnog djelovanja heroina na depresiju disanja. U ovom prikazu slučaja radi se o 40-godišnjem bolesniku koji je zaprimljen na Objedinjeni hitni prijam KB Sveti Duh zbog povišene temperature praćene zimicom, otežanim disanjem i bolovima u lijevoj strani prsišta. Obradom je utvrđena višestruka plućna patologija kao posljedica intravenske primjene drobljenog metadona, a koja je uključivala submasivnu plućnu emboliju, obostranu upalu pluća, poremećaj plućnog intersticija, multiple infarkte pluća te lijevostrani pleuralni izljev. Nakon početne obrade bolesnik je premješten u Jedinicu intenzivnog liječenja gdje je provedeno liječenje nefrakcioniranim heparinom, intravenskim antibioticima, antifungicima, vitaminom B12 te ostalom simptomatskom terapijom. Nakon provedenog liječenja u bolesnika je došlo do poboljšanja laboratorijskih i radioloških nalaza te subjektivnog stanja. Zbog nespecifi čne simptomatologije, te odsustva karakterističnih kliničkih znakova uz često višestruku plućnu patologiju u bolesnika koji uzimaju drogu postavljanje dijagnoze ponekad je izuzetno teško. Iz tog razloga, u svih ovisnika o drogama važan je visok stupanj sumnje uz organizirani dijagnostičko terapijski pristup kako bi se na vrijeme započelo liječenje potencijalno smrtonosnih plućnih komplikacija.A 40-year-old patient with fever, chills and pain in the left side of the chest presented to the Emergency Room (ER), Sveti Duh University Hospital. He had been on dual antibiotic therapy for the last 12 days. He was an otherwise treated opiate addict, now on methadone therapy. History data and physical examination were without particular features, vital indicators were normal, and soon after antipyretic and analgesic therapy the patient reported improvement and suggested discharge from ER. However, upon arrival of the fi ndings, in particular radiological heart and lung examination, additional diagnostic workup was performed. Radiograph of the heart and lungs revealed diffusely decreased ventilation of pulmonary parenchyma bilaterally (reticular nodose interstitium), pronounced vasculature, and intense shadow along the lateral thoracic wall to the right in the basal parts of the upper lobe. Also, due to the radiological fi ndings described, the subsequently mentioned dyspnea and acknowledgment of intravenous administration of crushed methadone and high d-dimer values, multi-slice computed tomography pulmonary angiography was performed, which indicated embolus in the left main branch of the pulmonary artery and in the lobar branch to the lower lobe, right along with peripheral multiple lung infarctions. At the end of ER treatment, it was concluded that the patient had submassive pulmonary embolism, bilateral pneumonia, changes in pulmonary interstitium, and multiple pulmonary infarctions. As a result, the patient was hospitalized in the Intensive Care Unit, treated with unfractionated heparin, intravenous antibiotics, antifungals, vitamin B12 and other symptomatic therapy. After treatment, laboratory and radiological fi ndings and the subjective condition of the patient improved, and he was discharged for home treatment with continued anticoagulation therapy

Ortostatika i kronična venska insuficijencija u hrvatskih stomatologa

The purpose of the study was to point to occupational exposure of dental medicine doctors in Croatia and to the effect of static performance on developing venous disease. The study included 120 subjects, 60 of them doctors of dental medicine and 60 from other professions. The study was focused on finding a way to upgrade preventive measures against developing chronic venous insufficiency and the quality of life of dental medicine doctors. Study subjects underwent verbal testing (questionnaire), clinical examination and ultrasonography (color Doppler).U radu se ukazuje na utjecaj profesionalne izloženosti doktora dentalne medicine u Hrvatskoj te na statičko opterećenje u odnosu na razvoj bolesti venskog sustava. Istraživanje je obuhvatilo 120 ispitanika, od toga 60 doktora dentalne medicine i 60 ispitanika drugih struka. Cilj istraživanja ponajprije je unaprjeđenje preventivnih mjera kojima bi se spriječio razvoj kronične venske insuficijencije, ali i poboljšanje kvalitete života naših ispitanika. Ispitanici su podvrgnuti usmenom anketiranju (anketni upitnik), kliničkom pregledu te ultrazvučnoj dijagnostici (obojeni Doppler)

INTRAVENOUS ADMINISTRATION OF CRUSHED METHADONE AND LUNG DISEASE

Ovisnost o drogama je čimbenik rizika za nastanak brojnih akutnih i kroničnih komplikacija pluća koje se mogu razviti zbog lošeg općeg zdravlja ovisnika, ali i zbog izravnog djelovanja heroina na depresiju disanja. U ovom prikazu slučaja radi se o 40-godišnjem bolesniku koji je zaprimljen na Objedinjeni hitni prijam KB Sveti Duh zbog povišene temperature praćene zimicom, otežanim disanjem i bolovima u lijevoj strani prsišta. Obradom je utvrđena višestruka plućna patologija kao posljedica intravenske primjene drobljenog metadona, a koja je uključivala submasivnu plućnu emboliju, obostranu upalu pluća, poremećaj plućnog intersticija, multiple infarkte pluća te lijevostrani pleuralni izljev. Nakon početne obrade bolesnik je premješten u Jedinicu intenzivnog liječenja gdje je provedeno liječenje nefrakcioniranim heparinom, intravenskim antibioticima, antifungicima, vitaminom B12 te ostalom simptomatskom terapijom. Nakon provedenog liječenja u bolesnika je došlo do poboljšanja laboratorijskih i radioloških nalaza te subjektivnog stanja. Zbog nespecifi čne simptomatologije, te odsustva karakterističnih kliničkih znakova uz često višestruku plućnu patologiju u bolesnika koji uzimaju drogu postavljanje dijagnoze ponekad je izuzetno teško. Iz tog razloga, u svih ovisnika o drogama važan je visok stupanj sumnje uz organizirani dijagnostičko terapijski pristup kako bi se na vrijeme započelo liječenje potencijalno smrtonosnih plućnih komplikacija.A 40-year-old patient with fever, chills and pain in the left side of the chest presented to the Emergency Room (ER), Sveti Duh University Hospital. He had been on dual antibiotic therapy for the last 12 days. He was an otherwise treated opiate addict, now on methadone therapy. History data and physical examination were without particular features, vital indicators were normal, and soon after antipyretic and analgesic therapy the patient reported improvement and suggested discharge from ER. However, upon arrival of the fi ndings, in particular radiological heart and lung examination, additional diagnostic workup was performed. Radiograph of the heart and lungs revealed diffusely decreased ventilation of pulmonary parenchyma bilaterally (reticular nodose interstitium), pronounced vasculature, and intense shadow along the lateral thoracic wall to the right in the basal parts of the upper lobe. Also, due to the radiological fi ndings described, the subsequently mentioned dyspnea and acknowledgment of intravenous administration of crushed methadone and high d-dimer values, multi-slice computed tomography pulmonary angiography was performed, which indicated embolus in the left main branch of the pulmonary artery and in the lobar branch to the lower lobe, right along with peripheral multiple lung infarctions. At the end of ER treatment, it was concluded that the patient had submassive pulmonary embolism, bilateral pneumonia, changes in pulmonary interstitium, and multiple pulmonary infarctions. As a result, the patient was hospitalized in the Intensive Care Unit, treated with unfractionated heparin, intravenous antibiotics, antifungals, vitamin B12 and other symptomatic therapy. After treatment, laboratory and radiological fi ndings and the subjective condition of the patient improved, and he was discharged for home treatment with continued anticoagulation therapy

Blokovi perifernih živaca u bolesnika s prijelomom kuka

Hip fractures represent a major public health issue with increasing incidence as a population ages. The aim of this review is to describe peripheral nerve block techniques (the fascia iliaca compartment block and the pericapsular nerve group block) as pain management for hip fractures in emergency medicine, and to emphasize their benefits. Hip fractures are extremely painful injuries. The pain itself is unpleasant for patients and if left untreated it can lead to multiple complications during preoperative, operative and postoperative patient management. Pain management for elderly hip fracture patients is often challenging. Non-steroidal anti-inflammatory drugs are not recommended due to their side effects, the increased risk of gastrointestinal bleeding, renal function impairment and platelet aggregation inhibition. Paracetamol alone is often insufficient, and opioids have many potentially harmful side effects, such as delirium development. Peripheral nerve blocks for hip fractures are safe and effective, also in emergency medicine settings. The benefits for patients are greater pain relief, especially during movement, less opioid requirements and decreased incidence of delirium. Regional analgesia should be routinely used in hip fracture pain management.Prijelom kuka predstavlja značajan javno zdravstveni problem čija će incidencija rasti sa starenjem populacije. Cilj ovog preglednog članka je opisati blokove perifernih živaca u liječenju boli kod bolesnika s prijelomom kuka, (bloka ilijakalne fascije i bloka perikapsularnih živaca), te naglasiti prednosti njihove primjene. Prijelom kuka je izrazito bolna ozljeda. Bol sama po sebi je neugodna za bolesnika, a ukoliko je neodgovarajuće liječena može dovesti do višestrukih komplikacija tijekom prijeoperacijskog, operacijskog i poslijeoperacijskog zbrinjavanja bolesnika. Unatoč postojanju brojnih analgetika, liječenje boli u starijih bolesnika s prijelomom kuka često je zahtjevno. Nesteroidni protuupalni lijekovi se ne preporučuju radi svojih neželjenih učinaka, paracetamol je često nedovoljan, a opioidi također mogu imati brojne neželjene učinke, uključujući razvoj akutnog smetenog stanja. Primjena blokova perifernih živaca je sigurna i učinkovita, također u uvjetima hitne medicine. Koristi za bolesnike su bolje ublažavanje boli, osobito prilikom pomicanja, smanjena potreba za primjenom opioida i smanjena incidencija akutnog smetenog stanja. Primjena blokova perifenih živaca u liječenju boli kod bolesnika s prijelomom kuka trebala bi postati svakodnevnica u kliničkoj praksi

Bilateral Synchronous Breast Cancer

We report a rare case of synchronous bilateral breast cancer in 79-year old female patient treated at our hospital. The tumors were discovered one year ago after a complete clinical and radiological (mammography, US) examination with cytopunction of tumor masses. Results came back and showed carcinomas of both breasts. Patient underwent surgical removal of the both breasts with bilateral axillary lymphadenectomy. Later histological examination confirmed earlier diagnosis of invasive ductal carcinoma in both breasts in a G3 stage. After surgical removal of the tumors patient was also treated with radiotherapy. One year after bilateral mastectomy and axillary lymphadenectomy, clinical and radiological examination that included mammography and ultrasound of breast with tumor marker C15-3 which was 2.8, we did not found recurrence of the tumor

THERAPEUTIC APPROACH TO HEMORRHAGIC SHOCK CAUSED BY RADIATION PROCTITIS

Radijacijski proktitis označava upalu i oštećenje donjih dijelova debelog crijeva koji nastaju nakon izlaganja rendgenskom zračenju ili drugim ionizirajućim zračenjima u sklopu radijacijske terapije zloćudnih tumora zdjelice. Studije pokazuju da se u 50-70 % bolesnika razvija akutno, a u 5-11 % kronično oštećenje gastrointestinalnog sustava. Mehanizam ozljede uključuje izravno oštećenje molekule DNA te stvaranje slobodnih radikala kisika koji oštećuju mukozu, submukozu i mišićni sloj te na kraju seroznu ovojnicu crijeva. U ovom članku prikazujemo bolesnika kod kojeg je 2,5 godine nakon provedenog zračenja zbog karcinoma prostate došlo do razvoja hemoragičnog radijacijskog proktitisa praćenog masivnim krvarenjem i razvojem hemoragičnog šoka. Iako ne postoji standardni protokol liječenja, postoje određene terapijske mogućnosti koje se danas koriste u liječenju hemoragičnog radijacijskog proktitisa, a uključuju primjenu protuupalnih lijekova i antioksidansa, traneksamične kiseline, lokalnu primjenu formalina, kortikosteroida u obliku klizmi, argon plazma koagulaciju, radiofrekventnu ablaciju, hiperbarični kisik te kirurški zahvat. Na temelju prikazanog bolesnika postavlja se pitanje kirurškog liječenja i krajnje potrebe za takvom terapijom.Radiation proctitis indicates infl ammation and damage to lower parts of the colon that occur after exposure to x-ray radiation or other ionizing radiation in the context of radiation therapy of malignant pelvic tumors. Studies show that 50%-70% of patients develop acute and 5%-11% chronic gastrointestinal impairment. The mechanism of injury involves direct damage to the DNA molecule and formation of free radical oxygen that damages mucosa, submucosa and muscle layer, and eventually the serous intestinal lining. In this article, we present a patient in whom hemorrhagic radiation proctitis developed 2.5 years after radiation therapy for prostate carcinoma, which was followed by massive bleeding and hemorrhagic shock. Although there is no standard treatment regimen, there are certain therapeutic options that are currently used in the treatment of hemorrhagic radiation proctitis, and include the use of anti-infl ammatory drugs and antioxidants, tranexamic acid, local use of formalin, slip-shaped corticosteroid, argon plasma coagulation, radiofrequency ablation, hyperbaric oxygen and surgical procedure. On the basis of the present case, the issue of surgical treatment and the extreme need for it are highlighted

Korelacija kliničke slike plućne embolije i vrijednosti D-dimera s MSCT plućnom angiografijom i njezina opravdanost u hitnoj službi

Cilj istraživanja: utvrditi korelaciju kliničke vjerojatnosti (Wellsov bodovni sustav) i vrijednosti D-dimera s MSCT plućnom angiografijom i njezinu opravdanost u hitnoj službi Nacrt studije: ova case control studija provedena je u OHBP-u Kliničke bolnice „Sveti Duh“ u razdoblju od siječnja do kraja prosinca 2019. godine. Ispitanici i metode: u ispitivanom vremenskom razdoblju od godinu dana u OHBP-u (internističke ambulante) KB „Sveti Duh“ pregledano je 22 252 bolesnika. Na temelju kliničke slike, Wellsovog skora i povišenih vrijednosti D-dimera postavljena je sumnja na PE u 305 bolesnika. Kod 149 dijagnoza PE je potvrđena MSCT plućnom angiografijom, dok je kod preostalih 156 bolesnika ona isključena. Nakon uzimanja anamnestičkih podataka i fizikalnog pregleda bilježili smo vitalne pokazatelje (frekvenciju disanja, srčanu frekvenciju i zasićenost krvi kisikom na periferiji) i Wellsov bodovni skor (procijena kliničke vjerojatnosti) te su uzeti uzorci krvi za laboratorijsku analizu (D-dimeri, troponin, BNP). Na temelju prikupljenih informacija bolesnici su upućeni na MSCT plućnu angiografiju, čime je dijagnoza plućne embolije potvrđena ili isključena. Rezultati: u 149 bolesnika u hitnoj službi KB „Sveti Duh“ postavljena je dijagnoza PE što je učestalost od 0,7%. Većina bolesnika (>80%) bila je starija od 60 godina te je oko 60% bolesnika bilo ženskog spola. Za Wellsov skor, D-dimere, troponin, frekvenciju disanja i SpO2 nađene su statistički značajne razlike između skupina bolesnika kojima je potvrđena, odnosno isključena dijagnoza PE (p70% bolesnika s masivnom plućnom embolijom nađena je i DVT donjih ekstremiteta. Kod 75% bolesnika s jašućim embolusom nije potvrđena DVT donjih ekstremiteta, čime pretpostavljamo porijeklo embolusa iz zdjeličnih vena (izostanak potvrde DVT zdjeličnih vena čini ograničenje našeg istraživanja). S obzirom da je u 48,85% bolesnika (149/305) MSCT plućnom angiografijom potvrđena dijagnoza PE mišljenja smo da je njezina primjena opravdana u hitnoj službi. Zaključak: niski stupanj kliničke vjerojatnosti (Wellsov bodovni sustav) zajedno s normalnom koncentracijom D-dimera sigurna je strategija u isključenju dijagnoze PE. Kako PE zbog raznolike i nespecifične kliničke slike može proći neprepoznato, Wellsov skor i D-dimeri čine važan dijagnostički algoritam u ranom prepoznavanju i dijagnosticiranju PE. Bolesnici niskog rizika (Wellsov skor) i s normalnom koncentracijom D-dimera ne trebaju antikoagulantnu terapiju, dok se bolesnici niskog rizika, ali s potvrđenom dijagnozom PE mogu i ambulantno liječiti, što je u skladu s trenutno važećim smjernicama. MSCT plućna angiografija predstavlja dijagnostički zlatni standard, a prema rezultatima našeg istraživanja njezina je primjena u hitnoj službi opravdana kod kliničke sumnje na plućnu emboliju.Research goal: to determine the correlation of clinical probability (Wells scoring system) and D-dimer values with MSCT pulmonary angiography and its justification in the emergency department Draft study: this case control study was conducted at the ED of the Clinical Hospital "Sveti Duh" in the period from January to the end of December 2019. Subjects and methods: In the study period of one year, 22 252 patients were examined in the ED (internal medicine clinic) of the Clinical Hospital "Sveti Duh". Based on the clinical presentation, Wells score, and elevated D-dimer values, PE was suspected in 305 patients. In 149 of them, the diagnosis of PE was confirmed by MSCT pulmonary angiography, while in the remaining 156 patients it was excluded. After taking anamnestic data and physical examination, we recorded vital signs (respiratory rate, heart rate and peripheral oxygen saturation) and Wells score (clinical probability assessment) and blood samples were taken for laboratory analysis (D-dimers, troponin, BNP). Based on the information collected, patients were referred for MSCT pulmonary angiography, thus confirming or excluding the diagnosis of pulmonary embolism. Results: 149 patients in the emergency department of KB "Sveti Duh" were diagnosed with PE, which has an incidence of 0.7%. The majority of patients (> 80%) were older than 60 years and about 60% of patients were female. For the Wells score, D-dimers, troponin, respiratory rate and SpO2, statistically significant differences were found between the groups of patients whose diagnosis of PE was confirmed or excluded (p 70% of patients with massive pulmonary embolism. In 75% of patients with riding embolism, DVT of the lower extremities was not confirmed, suggesting the origin of embolism from the pelvic veins (the absence of confirmation of DVT of the pelvic veins is a limitation of our study). Given that in 48.85% of patients (149/305) MSCT pulmonary angiography confirmed the diagnosis of PE, we are of the opinion that its use is justified in the emergency department. Conclusion: a low degree of clinical probability (Wells scoring system) along with a normal D-dimer concentration is a safe strategy in excluding the diagnosis of PE. As PE may go unrecognized due to its diverse and nonspecific clinical picture, Wells score and D-dimers constitute an important diagnostic algorithm in the early detection and diagnosis of PE. Low-risk patients (Wells score) and with normal D-dimer concentrations do not need anticoagulant therapy, while low-risk patients with a confirmed diagnosis of PE can be treated on an outpatient basis, which is in line with current guidelines. MSCT pulmonary angiography is the diagnostic gold standard, and according to the results of our research, its use in the emergency department is justified in case of clinical suspicion of pulmonary embolism