Emergency Medicine Cases Ep 203 Intermediate Risk Pulmonary Embolism Risk Stratification, Management and Algorithm
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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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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.
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.
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.