The treatment of choice in a patient with Massive Pulmonary Embolism in Shock is:
Answer is A (Thrombolytic Therapy): Normotension with Right ventricular hypokinesia suggests a diagnosis of submassive pulmonary embolism and stratifies the patient into an intermediate risk category. Treatment for intermediate risk patients with submassive PE is controversial. Guidelines recommend individual risk assessment for the thrombotic burden versus risk of bleeding. According to Harrisons textbook young patients without any comorbidities that fall into the intermediate risk category are excellent candidates for thrombolysis. The patient in question is a young 20 years old patient and the question makes no mention of any comorbidities, hence thrombolysis is the single best answer of choice.
Thrombolytic Therapy
Low Molecular Weight Heparin
Aggressive fluid resuscitation
Diuretic Therapy