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High-risk pulmonary embolism — SCE Respiratory MCQ

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HardPulmonary vascular diseaseHigh-risk pulmonary embolismSCE Respiratory

A 62-year-old man with metastatic pancreatic cancer collapses on the ward. He is hypotensive at 78/42 mmHg, tachycardic and hypoxaemic despite high-flow oxygen. Bedside echocardiography shows a dilated, hypokinetic right ventricle and CT pulmonary angiography confirms large bilateral pulmonary emboli. There is no recent surgery or intracranial bleeding history. What is the most appropriate management?

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Correct answer: C — Systemic thrombolysis after senior risk assessment

Haemodynamic instability with confirmed PE is high-risk PE, where thrombolysis is considered if bleeding risk is acceptable. DOAC outpatient treatment is for selected low-risk patients, not shock. Cancer increases thrombosis risk but does not by itself remove the need for reperfusion when PE is life-threatening.

Reference: NICE NG158; ESC PE guidance