A 49-year-old woman with pleuritic chest pain and syncope is hypotensive at 82/50 mmHg. Oxygen saturation is 88% on non-rebreather. Bedside

Question

A 49-year-old woman with pleuritic chest pain and syncope is hypotensive at 82/50 mmHg. Oxygen saturation is 88% on non-rebreather. Bedside ultrasound shows a dilated right ventricle; ECG shows sinus tachycardia and troponin is mildly elevated. What is the most appropriate next step?

Accepted Answer

Give systemic thrombolysis for presumed massive pulmonary embolism after excluding major contraindications

Answer

Give high-dose nitrates for pulmonary oedema

Answer

Arrange routine V/Q scan next week

Answer

Start outpatient direct oral anticoagulant and discharge

Answer

Treat with inhaled bronchodilator alone

Massive pulmonary embolism — RCPSC EM MCQ

A 49-year-old woman with pleuritic chest pain and syncope is hypotensive at 82/50 mmHg. Oxygen saturation is 88% on non-rebreather. Bedside ultrasound shows a dilated right ventricle; ECG shows sinus tachycardia and troponin is mildly elevated. What is the most appropriate next step?