Pre-Quiz: Acute Management of Pulmonary Embolism

A 35-year-old obese woman with a history of recent knee surgery, immobilized in a brace, presents to the ED after experiencing syncope, feelings of dizziness, and weakness. She is currently taking metformin, oral contraceptive pills, and sumatriptan. On examination, she appears anxious and reports feelings of dizziness upon ambulation. Her vital signs are temperature 99.3°F (37.4°C), blood pressure 72/48 mmHg, pulse 177 bpm, respirations 29 breaths/min, and oxygen saturation 82% on room air. Echocardiography reveals a dilated right ventricle with septal bulging and a hyperdynamic left ventricle.

What is the most appropriate next step in managing this patient?

A 62-year-old woman with a history of breast cancer and recent chemotherapy presents to the emergency department with sudden onset of shortness of breath and chest pain. Her vitals are: blood pressure 100/70 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, and oxygen saturation 92% on room air. A CT angiogram confirms the diagnosis of a pulmonary embolism. She has no known drug allergies. As a clinical pharmacist, you are asked to recommend the most appropriate anticoagulant therapy for this patient. She has a known allergy to apixaban and a history of poor INR control with warfarin. What would be your recommendation?

A 68-year-old man arrives at the emergency department with acute PE and hypotension. He has a history of gastrointestinal bleeding, deeming him a high bleeding risk. As a clinical pharmacist, you’re reviewing the 2021 CHEST guidelines for patients with acute PE, hypotension, and specific complicating factors. What intervention does CHEST suggest in such cases, provided the necessary expertise and resources are available?

A 70-year-old woman with acute PE but stable vitals is considered for thrombolytic therapy. As a clinical pharmacist, you consult the 2021 CHEST guidelines regarding thrombolytic administration methods. What does CHEST suggest for patients with acute PE needing thrombolysis?

A 44-year-old woman presents to the Emergency Department with symptoms including a rapid heart rate of 110 bpm, respiratory rate of 20 breaths per minute, blood pressure of 130/85 mmHg, and oxygen saturation of 98% on room air. She reports recent long flights. An ultrasound confirms deep vein thrombosis, and her CBC indicates elevated D-dimer levels. Her stable vitals suggest the PE is not massive. As a clinical pharmacist, what is your immediate recommendation for pharmacotherapy?