Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe dyspnea, pleuritic chest pain, and syncope. Symptoms are associated with tachycardia, tachypnea, and clinical signs of right ventricular strain. No prior history of DVT/PE; however, patient reports recent immobilization/surgery. Hemodynamic status is currently [stable/unstable].
Clinical Examination Findings
General: Patient appears distressed, tachypneic, and diaphoretic. Cardiovascular: Tachycardic, S1/S2 normal, possible S3 gallop, elevated JVP. Respiratory: Clear to auscultation bilaterally, tachypneic. Extremities: Unilateral lower extremity edema with tenderness and erythema, suggestive of DVT. Vitals: Hypoxemia noted on room air, hypotension may be present.
Treatment Protocol
Immediate initiation of anticoagulation therapy (e.g., LMWH or UFH). If hemodynamically unstable, consider systemic thrombolysis (tPA) or surgical embolectomy. Supplemental oxygen to maintain SpO2 >92%. Fluid resuscitation as indicated. Continuous cardiac monitoring and serial echocardiography to assess right ventricular function.