Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe dyspnea, pleuritic chest pain, and syncope. Hemodynamic instability noted with persistent hypotension (SBP <90 mmHg) and tachycardia. History significant for recent immobilization/surgery/malignancy. Symptoms associated with diaphoresis, lightheadedness, and profound hypoxia.
Clinical Examination Findings
Patient appears in acute distress, cyanotic, and tachypneic. Cardiovascular: Tachycardia, elevated JVP, loud P2, and signs of right ventricular strain. Pulmonary: Clear to auscultation bilaterally, no wheezing. Extremities: Unilateral lower extremity edema with tenderness and erythema consistent with DVT. Neurological: Altered mental status secondary to hypoperfusion.
Treatment Protocol
Immediate stabilization initiated. ABCs secured. Fluid resuscitation with caution. Systemic thrombolysis (tPA) indicated for massive PE with hemodynamic instability. Anticoagulation with UFH infusion. Consider surgical embolectomy or catheter-directed therapy if thrombolysis is contraindicated or fails. Continuous monitoring in ICU.