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Massive pulmonary embolism — SCE Respiratory MCQ

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HardPulmonary Vascular DiseaseMassive pulmonary embolismSCE Respiratory

A 24-year-old woman presents with massive PE. She is hypotensive despite fluids, oxygen saturation is 86% and echocardiography shows acute RV dilatation. There is no absolute contraindication to thrombolysis. What is the most appropriate management?

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Correct answer: D — Urgent systemic thrombolysis with anticoagulation and critical care support

Haemodynamic instability with confirmed or highly likely massive PE is an indication for urgent reperfusion therapy such as systemic thrombolysis if no contraindication exists, alongside anticoagulation and critical care support. Outpatient anticoagulation is inappropriate in shock. D-dimer testing is not useful in this high-risk emergency.

Reference: NICE NG158 Venous thromboembolic diseases; ESC PE guidance