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High-risk pulmonary embolism — SCE Respiratory MCQ

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EasyPulmonary Vascular DiseaseHigh-risk pulmonary embolismSCE Respiratory

A 67-year-old man collapses with suspected PE. He is hypotensive at 78/42 mmHg, tachycardic and hypoxic; bedside echo shows right ventricular dilatation and septal flattening. CTPA is not immediately possible because he is too unstable to transfer. What is the most appropriate management?

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Correct answer: E — Immediate reperfusion treatment for high-risk PE after senior review

Shock with echo evidence of acute right ventricular strain indicates high-risk PE; reperfusion such as systemic thrombolysis should be considered urgently after senior review. Waiting for outpatient imaging is unsafe when the patient is unstable. Aspirin and supportive outpatient measures do not treat obstructive shock.

Reference: NICE NG158; ESC Pulmonary Embolism Guideline