Approach to Suspected Pulmonary Embolism and RV Dysfunction in Critical Care Settings

In cases of suspected pulmonary embolism, obtaining a CT scan with contrast is crucial even in patients with renal dysfunction, as delaying the scan due to concerns about contrast can lead to missed diagnoses. Thrombolysis can be considered in unstable patients with a high pre-test probability of PE, but caution must be exercised due to the risk of bleeding if the diagnosis is incorrect. RV dysfunction is a key driver of hemodynamic instability in pulmonary embolism, leading to a death spiral where increasing pulmonary pressures cause RV dilation, impairing perfusion and leading to a rapid deterioration in the patient's condition. Interventions to prevent RV dysfunction include avoiding excessive fluid administration, as this can worsen the condition by facilitating RV dilation. Understanding and addressing the mechanisms behind RV dysfunction is crucial in managing and stabilizing patients with pulmonary embolism.