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Massive Pulmonary Embolism-Arrest — MRCEM SBA MCQ

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HardEmergency MedicineMassive Pulmonary Embolism-ArrestMRCEM SBA

A 62-year-old has sudden collapse, obstructive shock and pulseless electrical activity. Pulmonary embolism is strongly suspected and there is no known absolute contraindication to thrombolysis. In addition to standard cardiac-arrest care, what should the team consider?

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Correct answer: C — Give systemic thrombolysis during resuscitation for suspected pulmonary embolism

The best answer is “Give systemic thrombolysis during resuscitation for suspected pulmonary embolism”. When pulmonary embolism is a likely reversible cause of cardiac arrest, thrombolysis should be considered during resuscitation if there is no absolute contraindication. CT confirmation is impossible in an unstable arrest and must not delay treatment. Oral anticoagulants and vena-cava filters do not provide immediate reperfusion in this setting.

Reference: NICE: Venous thromboembolic diseases—diagnosis and management (NG158): https://www.nice.org.uk/guidance/ng158