Adult Critical Care Specialty (ACCS) Practice Exam

In a patient with tachycardia and hypotension, what urgent treatment is recommended for a diagnosis of acute pulmonary embolism?

1. Fluid resuscitation

2. Immediate anticoagulation

3. Surgery

4. Diuretics

The correct answer is: Immediate anticoagulation

In the case of a patient presenting with tachycardia and hypotension due to an acute pulmonary embolism (PE), immediate anticoagulation is the recommended urgent treatment. The rationale behind this approach lies in the pathophysiology of pulmonary embolism, where a blood clot occludes pulmonary arteries, leading to impaired blood flow, reduced oxygenation, and hemodynamic instability. Immediate administration of anticoagulants helps to prevent further clot propagation and allows the body’s natural fibrinolytic processes to begin resolving the existing embolism. This is crucial in stabilizing the patient, as delaying anticoagulation can lead to greater morbidity or mortality due to the progressive nature of the embolism and the potential for right ventricular failure. While fluid resuscitation can play a role in supporting blood pressure, particularly in the case of obstructive shock, it does not address the underlying problem of the embolism itself and can potentially worsen pulmonary edema in certain situations. Surgical intervention may be considered in select cases, particularly with massive PE and hemodynamic collapse, but it is not the first step for urgent management in the typical scenario. Diuretics are not appropriate as initial therapy in this context; they are used primarily in managing fluid overload rather than addressing the acute