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Massive pulmonary embolism — ABEM Board MCQ

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HardPulmonary emergenciesMassive pulmonary embolismABEM Board

A 63-year-old man arrives as ESI 2 with progressive dyspnea and unilateral leg swelling. BP 78/46, HR 132, SpO2 84%, and bedside echo shows a dilated right ventricle. CT is unsafe due to instability. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: E — Administer systemic thrombolysis if no contraindication

Massive PE with obstructive shock and RV strain warrants immediate reperfusion therapy when contraindications are absent.

Reference: ACEP Clinical Policy: Acute Venous Thromboembolic Disease; CHEST VTE guideline