What is the recommended management for suspected pulmonary embolism with shock?

• A. Oxygen therapy only
• B. Anticoagulation alone
• C. Observation
• D. Immediate thrombolysis if no contraindications; if not eligible, surgical embolectomy or catheter-directed therapy

Answer: (D)

In massive pulmonary embolism presenting with shock, the clot is acutely blocking pulmonary blood flow and causing life-threatening hemodynamic collapse, so rapidly restoring perfusion is the priority. Immediate thrombolysis is recommended if there are no contraindications, because dissolving the clot quickly can rapidly improve blood flow to the lungs and the heart, stabilize the patient, and save lives. If systemic thrombolysis is not possible due to contraindications or if there is a high bleeding risk, surgical embolectomy or catheter-directed therapy to remove or dissolve the clot becomes the next best option. While oxygen support and anticoagulation are important parts of management, they do not address the underlying obstruction quickly enough in a shocked patient, and observation is inappropriate in this scenario.