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Massive pulmonary embolism causing cardiac arrest risk — SCE Acute Medicine MCQ

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HardCritical Care MedicineMassive pulmonary embolism causing cardiac arrest riskSCE Acute Medicine

A 62-year-old man collapses on the AMU with sudden dyspnoea after recent long-haul travel. Blood pressure is 68/40 mmHg, pulse 136/min and oxygen saturation is 84% despite high-flow oxygen. Bedside echo shows a dilated right ventricle with septal flattening. CTPA is not immediately possible because he is peri-arrest. What is the most appropriate next step in management?

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Correct answer: D — Give systemic thrombolysis for suspected massive PE

This is suspected high-risk PE with obstructive shock and echo evidence of RV failure; thrombolysis is appropriate when imaging cannot be obtained safely. D-dimer has no role in a peri-arrest high-probability presentation. Diuretics may worsen RV preload and shock. The pearl is that life-saving reperfusion may be justified on probability when collapse prevents definitive imaging.

Reference: NICE NG158; ESC PE guidance; Resuscitation Council UK ALS