A 35-year-old female with no past medical history presents to the emergency department with shortness of breath for two days. Heart rate is 115 bpm, respiratory rate is 26 bpm, blood pressure is 85/55, and oxygen saturation is 89% on room air. The patient is afebrile. Cardiac ultrasound is shown below. What is the most appropriate management of this patient’s condition?
A. Inotropic support
B. IV antibiotics
C. IV TPA
D. Pericardiocentesis
Answer: C. IV tPA
A. INCORRECT: Inotropic support
This patient’s presentation and ultrasound are concerning for an acute pulmonary embolus. Treatment should be aimed at addressing the clot itself.
B. INCORRECT: IV antibiotics
This patient’s presentation and ultrasound are concerning for acute pulmonary embolus. Antibiotics have no role in treatment for this condition.
C. CORRECT: IV TPA
The correct answer is IV TPA. This patient has an ultrasound suggestive of right ventricular strain likely due to a large pulmonary embolism. This is evident because the right ventricle is larger than the left ventricle in this view. Management of a hemodynamically unstable patient with a large PE is IV TPA.
D. INCORRECT: Pericardiocentesis
This patient’s presentation and ultrasound are concerning for acute pulmonary embolus. Pericardiocentesis would be indicated in cases of pericardial tamponade.
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