Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of dyspnea, pleuritic chest pain, and tachycardia. Hemodynamically stable (normotensive) but demonstrates evidence of right ventricular (RV) strain on imaging (CTPA showing RV/LV ratio >1.0) and/or elevated cardiac biomarkers (Troponin I/T or NT-proBNP). No signs of obstructive shock or persistent hypotension.
Clinical Examination Findings
Vitals: Tachycardic, tachypneic, O2 saturation borderline on room air. Cardiovascular: S2 accentuation (pulmonic component), possible tricuspid regurgitation murmur, JVD present. Respiratory: Clear to auscultation or mild bibasilar crackles. Extremities: Unilateral lower extremity swelling, erythema, and tenderness consistent with DVT.
Treatment Protocol
Initiate therapeutic anticoagulation (LMWH, UFH, or DOAC per protocol). Monitor for hemodynamic decompensation. Consider escalation to thrombolysis or embolectomy if clinical status deteriorates (signs of shock or end-organ hypoperfusion). Serial echocardiography or CTPA to assess RV function.