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Massive pulmonary embolism — SCE Respiratory MCQ

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HardPulmonary Vascular DiseaseMassive pulmonary embolismSCE Respiratory

A 64-year-old man collapses 5 days after hemicolectomy. BP is 78/42 mmHg, HR 128/min, SpO2 88% on oxygen and CT pulmonary angiography confirms bilateral central pulmonary emboli with right ventricular dilatation. There is no active bleeding. What is the most appropriate management?

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Correct answer: C — Urgent reperfusion therapy with systemic thrombolysis after senior risk assessment

Massive PE with shock and RV strain is life-threatening and requires urgent reperfusion, with systemic thrombolysis considered after balancing postoperative bleeding risk. Outpatient anticoagulation is unsuitable in haemodynamic collapse. IVC filter alone, aspirin or withholding treatment would not address obstructive shock from PE.

Reference: NICE NG158; ESC Pulmonary Embolism Guideline