A fictional 59-year-old with sudden dyspnoea and syncope is hypotensive and hypoxic after recent surgery. Bedside assessment raises strong suspicion of pulmonary embolism.
Listen for the assumption.
I calculated a Wells score and was waiting for a routine CTPA slot.
What changes when suspected PE is accompanied by shock?
The immediate problem is haemodynamic instability. Resuscitation, urgent expert imaging strategy and reperfusion discussion must occur now.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Persistent systolic hypotension
- Bedside findings suggest acute right-heart strain
- Recent surgery creates both VTE risk and bleeding complexity
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
I will coordinate oxygenation, circulation, imaging feasibility and anticoagulation while checking alternative causes of obstructive shock.
Good. Activate local high-risk PE support and document why systemic, catheter-directed or surgical options are being considered or rejected.
I will record the shock trajectory, bleeding context, treatment times and named decision maker.
What must remain explicit.
- Use the current local high-risk PE pathway.
- Escalate immediately to senior, critical-care and relevant reperfusion expertise.
- Document recent surgery, bleeding risk and the rationale for treatment decisions.
Where reasoning fails.
- Following a stable-patient algorithm despite shock
- Waiting for D-dimer
- Treating recent surgery as an automatic end to the discussion
Suspected high-risk PE with haemodynamics [trend], oxygenation [trend], supporting imaging [details], anticoagulation/reperfusion [status], bleeding risks [details] and immediate decision required [question].
Which roles need to be on the same call when PE, shock and major bleeding risk coexist?