Everyone with suspected VTE is now supposed to have some sort of investigation. This is where the ability to draw flowcharts would be really helpful:
Wells 2 or above – Doppler within 4 hours, or, if that’s not possible, get it within 24 hours and meanwhile do D-dimer test and start anticoagulant. If the D-dimer is positive and the scan negative, repeat it 6 – 8 days later (though that part won’t be my problem).
Wells <2 – D-dimer test, and, if positive, Doppler as per above timeframes (either within 4 hours, or within 24 hours with interim SC anticoagulant).
And lots of luck with getting that level of service in practice.
For suspected PE:
Wells score >4 – in practice, from my POV, comes down to ‘admit for immediate further investigation’. Wells score 4 or lower – D-dimer first, admit for further investigation if positive.