Acute pulmonary embolism: PESI risk stratification, thrombolysis, and PERT

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Meet the patient

A man in his sixties, days out from a hip replacement, sits up, says he cannot breathe, and slumps — tachypnoeic, hypoxic on high-flow oxygen, tachycardic, hypotensive with a raised lactate and JVP. The calf is swollen; lung fields clear. Bedside echo shows a dilated RV with McConnell's sign and a mobile right-atrial thrombus; CTPA confirms a saddle embolus.^[21][25]

The question that frames the next twenty minutes — and every PE you will see at 3am — is a single branch: is he haemodynamically stable or not? Stable gets risk-stratified; unstable gets lysed. Hold that fork and the rest of the pathway arranges itself beneath it.^[21]

References38ShowHide

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