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Massive pulmonary embolism — USMLE Step 3 MCQ

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HardEmergency MedicineMassive pulmonary embolismUSMLE Step 3

A 61-year-old woman presents with sudden dyspnea and pleuritic chest pain 10 days after knee replacement. Heart rate is 118/min, blood pressure is 86/54 mm Hg, oxygen saturation is 88% on room air, and CT pulmonary angiography shows large bilateral pulmonary emboli with right ventricular strain. Which of the following is the most appropriate next step in management?

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Correct answer: E — Give systemic thrombolysis if bleeding risk is acceptable

Hemodynamically unstable pulmonary embolism with shock is an indication for reperfusion therapy, typically systemic thrombolysis if bleeding risk is acceptable, along with anticoagulation.

Reference: CHEST pulmonary embolism guidance