A fictional 61-year-old becomes acutely breathless and syncopal six days after major surgery, with tachycardia, hypotension and clear lung fields.
Frame the danger first.
- Consider pulmonary embolism in otherwise unexplained acute dyspnoea, chest pain, syncope, hypoxaemia or haemodynamic compromise.
- Establish recent surgery, immobility, cancer, previous venous thromboembolism, pregnancy and bleeding risk.
- Do not allow a low oxygen requirement or non-specific ECG to provide false reassurance in an unstable presentation.
Act, escalate, reassess.
- Call for senior, critical-care and relevant specialty help while beginning ABCDE resuscitation and monitoring.
- Use the current local pulmonary-embolism pathway to coordinate urgent imaging or bedside assessment appropriate to stability.
- Obtain essential investigations and assess anticoagulation/thrombolysis contraindications without delaying emergency decisions.
- Plan monitored transfer and reassess haemodynamics continuously.
Red flags that change pace.
- Persistent hypotension, shock, syncope or rising lactate
- Severe hypoxaemia, altered consciousness or cardiac arrest
- Evidence of right-heart strain with clinical deterioration
What makes care less safe.
- Using a routine low-risk diagnostic pathway in a shocked patient
- Delaying specialist escalation until definitive imaging is available
- Starting treatment without checking major bleeding risks and recent procedures
Say the concern plainly.
Possible high-risk pulmonary embolism with [haemodynamic and respiratory findings], risk factors [summary] and bleeding risks [summary]. Diagnostic status is [state]; I need immediate senior/critical-care input for the reperfusion and anticoagulation plan.