Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of dyspnea, pleuritic chest pain, and tachycardia. Clinical assessment confirms submassive pulmonary embolism (PE) characterized by hemodynamic stability (systolic BP >90 mmHg) with evidence of right ventricular (RV) strain on echocardiography or elevated cardiac biomarkers (troponin/BNP). No signs of obstructive shock or hypotension.
Clinical Examination Findings
Vitals: Tachycardic, tachypneic, O2 saturation borderline on room air. Cardiovascular: S2 accentuation, possible tricuspid regurgitation murmur, JVD present. Pulmonary: Clear to auscultation or mild bibasilar crackles. Extremities: Unilateral lower extremity edema or tenderness suggestive of DVT. Neurological: Alert and oriented, no focal deficits.
Treatment Protocol
Initiate therapeutic anticoagulation (LMWH or UFH). Monitor for signs of clinical deterioration toward massive PE. Consider catheter-directed thrombolysis or surgical embolectomy if RV dysfunction progresses. Maintain hemodynamic support; avoid aggressive fluid resuscitation to prevent RV overdistension. Serial monitoring of troponin and echocardiographic RV/LV ratio.