A patient with confirmed PE and no fibrinolysis contraindication develops BP 76/44 mmHg, persistent altered mentation and lactate 5 mmol/L despite

Question

A patient with confirmed PE and no fibrinolysis contraindication develops BP 76/44 mmHg, persistent altered mentation and lactate 5 mmol/L despite fluids and norepinephrine. CT shows RV strain. What is the appropriate reperfusion plan?

Accepted Answer

Administer systemic thrombolysis while continuing resuscitation and anticoagulation management

Answer

Continue anticoagulation alone with monitored observation and serial biomarker measurement

Answer

Arrange routine next-day catheter consultation after stabilization with fluids

Answer

Discharge on a direct oral anticoagulant if blood pressure improves transiently

Answer

Hold anticoagulation until repeat CT confirms clot progression

High-risk non-ST-elevation ACS — RCPSC EM MCQ

A patient with confirmed PE and no fibrinolysis contraindication develops BP 76/44 mmHg, persistent altered mentation and lactate 5 mmol/L despite fluids and norepinephrine. CT shows RV strain. What is the appropriate reperfusion plan?