Pulmonary embolism

Clot in the lung is easy to under-call in a stable patient and easy to over-treat in the wrong patient.

• Sudden dyspnea, pleuritic pain, and a risk factor belong on the list.
• Shock or collapse is an emergency resuscitation problem, not an outpatient score.
• A stable patient needs a confirmatory pathway, not automatic thrombolysis.

Embolus blocks pulmonary arteries. Dead space rises. Blood is redirected through the remaining lung, which can lower oxygenation. A large clot obstructs the right ventricle.

Ask two questions: could this be clot, and is the right ventricle failing now?

• Unstable: resuscitate. Imaging is chosen by the emergency pathway, not by a clinic algorithm.
• Stable: probability, then a test that can confirm. A D-dimer is not a way to discharge shock.

Immediate

Oxygen if hypoxic, support of blood pressure if shocked, and a senior emergency decision about reperfusion when massive embolism is the working diagnosis.

Definitive

Anticoagulation when embolism is confirmed or when the probability is high enough that waiting is unsafe. The drug and dose are protocol-specific and are not on this page.

Monitoring

Bleeding, recurrence of shock, and the reason the clot happened.

• Sending a shocked postoperative patient home for a later D-dimer.
• Thrombolysing a stable patient because the story is classic.
• Forgetting bleeding risk when anticoagulation starts.

The discriminator is blood pressure and perfusion, not how dramatic the history sounds.

Opens original Mahazanaka questions in this subject. If this subject is thin on that track, the session uses what exists.

1. Recognize. Sudden dyspnea plus a risk.
2. Reason. Is this massive, or is there time to confirm?
3. Prioritize. Resuscitation before a probability essay.
4. Act safely. Match the step to stability.

• Day 6 after surgery, collapse, blood pressure 78/46. Is an outpatient D-dimer the right plan?

  Show reasoning