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Massive pulmonary embolism — RCPSC IM MCQ

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HardCritical CareMassive pulmonary embolismRCPSC IM

A 61-year-old woman collapses 2 weeks after hip fracture repair. Blood pressure is 76/42 mm Hg, oxygen saturation is 84 percent, ECG shows sinus tachycardia with right heart strain, bedside echocardiography shows severe right ventricular dilation, and CT pulmonary angiography confirms large bilateral pulmonary emboli. There is no intracranial bleeding history. What is the most appropriate management?

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Correct answer: C — Systemic thrombolysis with anticoagulation and ICU support

Pulmonary embolism with sustained hypotension is high-risk PE. In the absence of major contraindications, systemic thrombolysis plus anticoagulation and resuscitative support is appropriate.

Reference: Thrombosis Canada pulmonary embolism guidance