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Massive pulmonary embolism with shock — RCPSC EM MCQ

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HardCardiovascular emergenciesMassive pulmonary embolism with shockRCPSC EM

CTAS 1: A 48-year-old 10 days postpartum has sudden dyspnoea and syncope. Vitals are BP 74/42, HR 142, RR 32, SpO2 84%. POCUS shows RV dilation and septal bowing; ECG shows sinus tachycardia. No major bleeding risk is identified. What is the most appropriate next step?

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

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Correct answer: A — Give systemic thrombolysis while arranging critical care support

Shock with RV strain in suspected PE is high-risk PE. If no prohibitive contraindication exists, thrombolysis is indicated while resuscitation proceeds.

Reference: Thrombosis Canada VTE guidance; PEITHO/ESC principles adapted to Canadian practice