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Septic shock requiring vasopressors — SCE Acute Medicine MCQ

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HardCritical care medicineSeptic shock requiring vasopressorsSCE Acute Medicine

A 69-year-old woman with confirmed pulmonary embolism remains hypotensive at 76/44 mmHg after a cautious fluid challenge. Echocardiography shows right-ventricular dilatation and hypokinesis; there is no active bleeding or recent surgery. What is the most appropriate reperfusion strategy?

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Correct answer: E — Give systemic thrombolysis with concurrent critical-care support

Persistent hypotension with right-ventricular dysfunction defines high-risk pulmonary embolism. In the absence of a major contraindication, systemic thrombolysis is the immediate reperfusion treatment, supported by unfractionated heparin and critical care. Surgical embolectomy or catheter therapy is considered when thrombolysis is contraindicated or fails.

Reference: https://www.nice.org.uk/guidance/ng158/chapter/recommendations