A 45-year-old man is brought to the emergency department with severe dyspnea, diaphoresis, and syncope. His blood pressure is 72/48 mmHg, heart rate is 130 bpm, and oxygen saturation is 82% on 100% oxygen via non-rebreather mask. Bedside echocardiography shows a dilated right ventricle with interventricular septal bowing into the left ventricle. CT angiography is unavailable. Which of the following is the most appropriate next step?
- A)Place a bilateral lower extremity venous ultrasound
- B)Wait for CT angiography to become available
- C)Administer systemic thrombolysis with alteplaseGABARITO
- D)Perform urgent surgical embolectomy
- E)Start unfractionated heparin and observe
Explicação
This patient has massive PE with hemodynamic collapse. When clinical and echocardiographic findings are consistent with massive PE and the patient is in shock, systemic thrombolysis should not be delayed for confirmatory CT angiography. The bedside echo showin... Ver explicação completa e trilha adaptativa →