A 57-year-old woman presents with sudden dyspnoea and syncope. CTPA confirms large bilateral pulmonary emboli. Her blood pressure was 114/72 mmHg

Question

A 57-year-old woman presents with sudden dyspnoea and syncope. CTPA confirms large bilateral pulmonary emboli. Her blood pressure was 114/72 mmHg during imaging but has fallen to 78/44 mmHg and remains low after a cautious 250 mL crystalloid bolus. She is cool and clammy, with a lactate of 4.6 mmol/L. Bedside echocardiography shows a dilated right ventricle without pericardial effusion. She has no active bleeding, recent surgery or history of intracranial haemorrhage. Intravenous access and monitoring are established; she has not yet received anticoagulation. Which treatment and disposition plan is most appropriate?

Accepted Answer

Start continuous intravenous unfractionated heparin and arrange urgent systemic thrombolysis with critical care admission.

Answer

Start therapeutic low-molecular-weight heparin and arrange urgent systemic thrombolysis with critical care admission.

Answer

Start continuous intravenous unfractionated heparin and arrange critical care admission without reperfusion.

Answer

Start continuous intravenous unfractionated heparin and arrange urgent surgical embolectomy with critical care admission.

Answer

Start therapeutic apixaban and arrange critical care admission without reperfusion.

Haemodynamically unstable pulmonary embolism — MRCEM SBA MCQ