The Internet Book of Critical Care Podcast IBCC Episode 53 - Submassive & Massive Pulmonary Embolism
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Sep 10, 2019 Exploring controversies in classifying pulmonary embolisms, risk assessment, thrombolysis, anticoagulation, novel therapies, and managing crashing & hypoxemic PE patients. Topics include warning signs, severity categories, individualized care, dosing strategies for thrombolytic therapy, and challenges in managing PE patients in critical care settings.
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Bundle Labs Before Therapies
- Order a bundled initial lab set (INR, PTT, fibrinogen, D-dimer, lactate, troponin) early for suspected submassive/massive PE.
- Collect these before giving thrombolytics to avoid missing baseline values and aid decisions.
Respect Bradycardia And Tachypnea
- Treat bradycardia in PE as an ominous sign and act quickly with epinephrine and escalation.
- Use shock index and respiratory rate (>30) to identify patients at higher risk of deterioration.
RV Dilation Opens The Severity Door
- Right ventricular dilation is a prerequisite to calling a PE submassive or massive, but chronic RV changes can mislead.
- Always assess for acute versus chronic RV enlargement before assigning severity.