A patient with pulmonary embolism (PE) in ICU has a BP of 80/50 text mmHg , HR 130/text min , SpO_2 = 84%, and signs of right heart failure on echocardiogram. What is the classification and MOST appropriate immediate treatment?

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Nursing QUESTION #9248

Question 1

A patient with pulmonary embolism (PE) in ICU has a BP of \(80/50 \text{ mmHg}\), HR \(130/\text{min}\), SpO\(_2 = 84\%\), and signs of right heart failure on echocardiogram. What is the classification and MOST appropriate immediate treatment?

Submassive PE — start IV heparin infusion
Low-risk PE — give oral rivaroxaban
Massive PE — systemic thrombolysis with alteplase (if no contraindication)✔️
Submassive PE — surgical embolectomy immediately

Correct Answer Explanation

Correct Answer: C — Massive PE — systemic thrombolysis

PE Classification (ESC 2019):

Category	Criteria	Treatment
Massive (High Risk)	Hemodynamic instability: SBP \(< 90 \text{ mmHg}\) or drop \(\geq 40 \text{ mmHg}\) \(> 15\) min	Systemic thrombolysis or surgical embolectomy
Submassive (Intermediate)	Hemodynamically stable + RV dysfunction or elevated troponin/BNP	Anticoagulation ± consider thrombolysis
Low Risk	Hemodynamically stable, no RV dysfunction	Anticoagulation (DOAC or heparin)

Alteplase regimen for massive PE: \(100 \text{ mg}\) IV over 2 hours (or \(0.6 \text{ mg/kg}\) over 15 min max \(50 \text{ mg}\))

Absolute contraindications to thrombolysis include: prior intracranial hemorrhage, active bleeding, recent surgery \(< 3\) weeks. If contraindicated → surgical embolectomy or catheter-directed thrombolysis.

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