79) A 38-year old female on birth control pills, has suddenly become extremely short of breath. Someone has seen her collapse and called 911. She was diaphoretic and complained of severe chest pain before she collapsed. She is now in the ER/ED and you have been asked to evaluate her. Her old records show that she is a cocaine abuser and was admitted for subarachnoid hemorrhage 6 weeks ago from which she completely recovered. Clinical findings revealed Vitals : B.P 65/ palpable, R.R 45. Pulse 140, Tm: 99.2 F. Chest exam revealed decreased breath sounds in right lower lobe and distant heart sounds. Pulse oximetry revealed 88%. EKG showed sinus tachycardia with a q wave and T wave inversion in lead III. 2D echo showed global hypokinesis of the Right Ventricle and pulmonary hypertension. You started her on Intravenos fluids and her blood pressure has slightly improved to 66/30. Your next step in management ?
A) Transfer to cath lab and notify the interventional cardiologist stat
B) Intra aortic balloon counterpulsation
C) Thrombolytic therapy
D) Surgical Embolectomy and Inferior vena cava filter
E) Obtain cardiothoracic surgery consult for subxiphoid window
Filed under: USMLE Test Prep | Tagged: anticoagulation, cardiac catheterization, embolectomy, inferior vena cava filter, intra-aortic ballooon pump, IVC filter, pulmonary embolism, right ventricular MI, shock, subxiphoid window, thrombolytic therapy |
Archer USMLE Step 3 Blog 
D : unstable pt with PE, PMH subarachnoid hemorrhage