Emergency Medicine Cases

Ep 203 Intermediate Risk Pulmonary Embolism Risk Stratification, Management and Algorithm

41 snips
Apr 1, 2025
Dr. Lauren Westafer, a PE researcher and Foamcast host, along with Dr. Justin Morgenstern, a regular contributor to EM platforms, and Dr. Bourke Tillman, an intensivist, dive into the complexities of managing intermediate-risk pulmonary embolism (PE). They discuss vital risk stratification techniques, including the use of biomarkers and imaging. The conversation also highlights crucial treatment decisions, weighing thrombolysis against anticoagulation, and the role of clinical judgment in dynamic situations. Their insights aim to enhance emergency care strategies for this challenging condition.
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INSIGHT

Understanding PE Risk Stratification

The intermediate risk pulmonary embolism group is highly heterogeneous, requiring nuanced clinical judgment for management. Risk stratification tools often fail to accurately predict outcomes in these patients.

ANECDOTE

Case of the Saddle Embolism

A 30-year-old female presented with abrupt shortness of breath and signs of right heart strain. Despite being stabilized, she ultimately required frequent readmissions for severe pulmonary hypertension.

ADVICE

Thrombolysis Considerations

Only consider thrombolysis for intermediate risk patients who show signs of hemodynamic instability. Use lower doses of lytics to minimize risks of bleeding.

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