Critical Care Time 16. Pulmonary Embolism Part II
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Jan 29, 2024 In this podcast, the hosts discuss the pillars of PE management, including the use of lytics in non-massive PEs, airway management, and hemodynamics. They also highlight the importance of categorizing shock in PE and the need for personally assessing the patient. The results of a thrombolysis study and bleeding risks are discussed, along with different management options for PE patients. The seriousness of a clot in transit and the use of surgical embolectomy are explored, along with the use of ECMO as a treatment option. The podcast ends with acknowledgments and disclaimers.
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Risk Stratification in PE
- Risk-stratify PE patients using objective measures like the ESC guidelines, Bova, and PESI scores.
- Consider prior blood pressures and look for significant drops, as a 30-point drop can indicate shock.
Pillars of PE Treatment
- Treat PE using the four pillars: correcting hypoxemia, anticoagulation, hemodynamic optimization/PVR management, and thrombolysis/intervention.
- Consider forming a multidisciplinary PE response team (PERT) for faster, more coordinated decision-making.
Shunt vs. V/Q Mismatch
- Low oxygen saturation unresponsive to supplemental oxygen suggests a shunt, not V/Q mismatch.
- This can indicate a patent foramen ovale (PFO) opening due to increased right-sided pressures.