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Challenges and Changes to the Management of Pulmonary Embolism in the Emergency Department. The diagnosis and treatment of pulmonary embolism (PE) remains one of the great challenges of emergency medicine. The symptoms of PE are myriad, common, and nonspecific. Undertesting risks missing a potentially life-threatening illness, whereas overtesting adds cost, false-positive diagnoses, incidental findings, and potential adverse impacts from contrast and radiation. Once diagnosed, the severity of PE can range from truly insignificant to deadly, and treatment must be tailored appropriately to the situation. This review discusses basic tenets of emergency department diagnosis and management while highlighting current challenges and recent changes to PE treatment.