Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe dyspnea, pleuritic chest pain, and syncope. Symptoms associated with hemodynamic instability, including hypotension (systolic BP <90 mmHg) and tachycardia. No prior history of DVT/PE, recent surgery, or prolonged immobilization noted.
Clinical Examination Findings
Patient is in acute distress, diaphoretic, and tachypneic. Cardiovascular: Tachycardia, S2 accentuation, jugular venous distension (JVD) present. Respiratory: Clear to auscultation bilaterally, but with rapid shallow breathing. Extremities: Unilateral lower extremity swelling and tenderness consistent with DVT. Neurological: Altered mental status secondary to cerebral hypoperfusion.
Treatment Protocol
Immediate initiation of hemodynamic support. Administer IV fluids cautiously. Initiate systemic thrombolysis (e.g., tPA) or consider surgical embolectomy/catheter-directed thrombolysis if contraindicated. Start therapeutic anticoagulation with unfractionated heparin. Monitor vitals and cardiac markers continuously in ICU setting.