Tasty Morsels of Critical Care Tasty Morsels of Critical Care 091 | Pulmonary Embolism Management
Nov 24, 2025
Dive into the complexities of managing pulmonary embolism, focusing on high-risk cases. Explore the critical interventions like thrombolysis and anticoagulation strategies, as well as the nuances of using inotropes and fluids. Learn about the role of CPR, the risks of intubation, and the controversial nature of catheter therapies. Discover the potential of VA ECMO as rescue support and the challenges of surgical embolectomy. Insightful discussions highlight the importance of swift decision-making in critical care!
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Give Thrombolysis When Indicated
- If PE is causing hypotension, give thrombolysis unless you have a strong contraindication.
- Use local hospital protocols for alteplase dosing (e.g., 10 mg bolus then 90 mg over 2 hours).
Thrombolysis Decisions Can Be Nuanced
- The decision to thrombolyse post-trauma is complex and highly patient-specific.
- Recent neurosurgical bleeds, laparotomy, or other injuries often sway clinicians away from lysis.
Prefer UFH In The ICU
- Start anticoagulation as a class 1 intervention in high-risk PE.
- Prefer unfractionated heparin in ICU because its effect dissipates quickly if bleeding occurs.