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Massive pulmonary embolism — RCPSC EM MCQ

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HardCardiovascular emergenciesMassive pulmonary embolismRCPSC EM

A 63-year-old woman presents with sudden dyspnoea, syncope and pleuritic chest pain. BP is 74/42, HR 138, SpO2 86%, and bedside echo shows severe RV dilation. She had hip arthroplasty 10 days ago. CT is unsafe because she is crashing. What is the most appropriate initial management?

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Correct answer: D — Give systemic thrombolysis for presumed massive pulmonary embolism

Obstructive shock with high pre-test probability of PE and RV failure supports emergent reperfusion when imaging is unsafe, balancing recent-surgery bleeding risk with imminent death.

Reference: ACLS/ATLS/PALS principles adapted to Canadian ED practice