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Massive pulmonary embolism — ABEM Board MCQ

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HardCardiovascular emergenciesMassive pulmonary embolismABEM Board

A 44-year-old woman collapses in the ED after 2 days of pleuritic chest pain. Triage acuity is ESI 1; BP 64/38 mm Hg, HR 142/min, SpO2 84% on nonrebreather. Bedside ultrasound shows severe right ventricular dilation and a compressed left ventricle. She has no history of intracranial bleeding or recent surgery. Which of the following is the most important immediate intervention?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give systemic thrombolysis while resuscitating

Hemodynamic collapse with RV strain strongly supports massive PE; systemic thrombolysis is indicated when contraindications are absent.

Reference: ACEP Acute Venous Thromboembolic Disease clinical policy; AHA PE guidance