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Respiratory Distress. Pulmonary Embolus. PEA Arrest. Shock. Hypoxia.

65-year-old male with chest pain and dyspnea. Has a syncopal episode brought to ED complaining of chest pain and dyspnea. Diagnosis is Submassive PE, case has a couple of options, can run as either the patient deteriorates into PEA arrest and requires thrombolysis or patient remains hemodynamically stable but has concomitant head trauma and thrombolysis is withheld.

Goals and Objectives

Educational Goal:

  • Approach to chest pain, respiratory distress in an unstable patient.

Objectives (Medical and CRM):

  • Approach to an undifferentiated patient with hypotension.
  • Generate a differential diagnosis including PE, Ischemia, tamponade, or aortic dissection and determine best imaging modalities/investigations to differentiate between the possible diagnosis.
  • Management of submassive vs massive PE.
  • Management of PEA arrest.
  • Indication for use of thrombolytics in massive PE.
  • Use closed-loop communication and frequent summaries in order to maintain effective communication and a shared mental model.

EPAs Assessed:

  • F1 Initiating and assisting in resuscitation of critically ill patients.
  • C3 Provide airway management and ventilation.
  • TD 3: Facilitating communication of information between a patient in the emergency department, caregivers, and members of the health care team to organize care and disposition of the patient.


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