SAQ 351 – Respiratory – pulmonary embolism classification and shock
Model Answer
Respiratory – pulmonary embolism classification and shock.
a. Classification
| Class | Definition |
|---|---|
| Massive PE | Acute PE with haemodynamic compromise: BP <90 for 15 minutes, vasopressor requirement, or pulselessness. |
| Submassive PE | Acute PE without haemodynamic compromise but with right-heart strain on ECG/echo/BNP or troponin leak. |
| Non-massive PE | Acute PE without the massive or submassive features. |
b. PERC features
- Age greater than 50.
- Heart rate 100 or more.
- Oxygen saturation on room air less than 95%.
- Prior DVT or PE.
- Recent trauma or surgery.
- Haemoptysis.
- Exogenous oestrogen use.
- Unilateral leg swelling.
c. Management
- Improve oxygenation with high-flow nasal oxygen around 50 L/min, titrating FiO2 to SaO2 92-96%.
- Support blood pressure with noradrenaline infusion targeting systolic BP about 90-100 mmHg.
- Systemic thrombolysis with IV alteplase: 50 mg bolus if deteriorating/arrest, or 100 mg total with 10 mg bolus then 90 mg over 90 minutes if stable enough.
d. Echo findings
- RV dilation greater than 0.9 of LV size.
- Reduced TAPSE.
- McConnell sign.
- Dilated IVC.
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