Obstructive Shock: Tamponade, Tension PTX, Massive PE

• Obstructive shock requires rapid cause-directed treatment: drain tamponade, decompress tension pneumothorax and select urgent PE reperfusion when indicated.
• For acute PE, use AHA/ACC Categories A–E. Activate a multidisciplinary PE response team early for Categories C–E and match anticoagulation or advanced therapy to severity, bleeding risk, anatomy and local expertise.
• Use focused ultrasound to support the differential and guide resuscitation; RV strain and absent lung sliding are not diagnostic by themselves.
• Suspected amniotic fluid embolism requires immediate multidisciplinary maternal resuscitation with parallel oxygenation, circulatory support, delivery assessment and early treatment of hemorrhage/coagulopathy.

Acute pulmonary embolism

First tests: Clinical pretest probability, 12-lead ECG, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: D-dimer, CT pulmonary angiography, Ventilation/perfusion imaging, Bedside echocardiography, Troponin and BNP/NT-proBNP, Venous compression ultrasound.

Repeat monitoring: Oxygenation, BP and perfusion.

Cardiac tamponade

First tests: Bedside echocardiography, 12-lead ECG, Full blood count.

Only if indicated: PT/INR, aPTT and fibrinogen, Pericardial fluid tests.

Repeat monitoring: Bedside echocardiography.

Pneumothorax / tension pneumothorax

First tests: Bedside respiratory and hemodynamic assessment.

Only if indicated: Lung/pleural ultrasound, Chest X-ray, CT chest.

Repeat monitoring: Oxygenation and respiratory examination.

Gas / air embolism

First tests: Immediate clinical and exposure assessment.

Only if indicated: Bedside echocardiography, Arterial blood gas, Noncontrast CT head.

Repeat monitoring: Serial neurological and cardiopulmonary assessment.

Suspected fat embolism syndrome

First tests: Clinical syndrome assessment, Arterial blood gas, Full blood count, Chest X-ray.

Only if indicated: CT pulmonary angiography, MRI brain.

Repeat monitoring: Oxygenation and neurological monitoring.

Suspected amniotic fluid embolism

First tests: Immediate maternal cardiorespiratory assessment, Full blood count, PT/INR, aPTT and fibrinogen, Blood group and crossmatch.

Only if indicated: Bedside echocardiography, Arterial blood gas.

Repeat monitoring: PT/INR, aPTT and fibrinogen.

• Mechanisms of Mechanical Shock
• Acute PE With Impending or Established Cardiopulmonary Failure
• Managing Gas Embolism Syndrome
• Managing Fat Embolism Syndrome
• Managing Amniotic Fluid Embolism Syndrome