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Massive pulmonary embolism with RV failure — FRCA Final MCQ

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HardICUMassive pulmonary embolism with RV failureFRCA Final

A 62-year-old man with massive pulmonary embolism is intubated in ICU. He is hypotensive despite noradrenaline, echocardiography shows a dilated right ventricle with septal flattening, lactate is 6.1 mmol/L and there is no recent surgery or intracranial bleeding. What is the most appropriate management?

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Correct answer: A — Give systemic thrombolysis after senior review

Massive PE with shock and RV failure is an indication for reperfusion therapy when bleeding risk is acceptable. Anticoagulation alone is too slow in haemodynamic collapse. Excessive PEEP and large fluid loading may worsen RV afterload and septal shift. Treatment should be coordinated with senior ICU, cardiology and haematology input.

Reference: ESC pulmonary embolism guideline; Faculty of Intensive Care Medicine standards