Emergency Medicine Cases Ep 204 High Risk Pulmonary Embolism Management
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May 13, 2025 In this discussion, experts Bourke Tillmann, Lauren Westafer, and Justin Morgenstern delve into the intricacies of managing high-risk pulmonary embolism. They highlight critical strategies for optimizing airway management and hemodynamic support. Advanced intubation techniques and the use of Laryngeal Mask Airways offer innovative solutions. Additionally, they address the significance of risk stratification and shared decision-making with patients, emphasizing the importance of tailored interventions and the management of complications to improve patient outcomes.
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RV Failure Spiral in PE
- Pulmonary embolism causes RV failure by blocking outflow and increasing afterload.
- RV dilation compresses LV, decreasing output and worsening shock in a deadly spiral.
Manage High-Risk PE Resuscitation
- Resuscitate high-risk PE patients like usual, but avoid intubation, PEEP, and high IV fluid volumes.
- Always treat the underlying clot with thrombolysis and consider early involvement of specialists.
Pre-Intubation Vasopressor Use
- Start vasopressors like norepinephrine before intubation to raise blood pressure.
- Have push-dose pressors (phenylephrine) ready for blood pressure swings during intubation.