Early intervention in massive pulmonary embolism. A guide to diagnosis and triage for the critical first hour.
The diagnosis of massive pulmonary embolism should be considered expeditiously in all patients with unexplained hypotension, syncope, cardiac arrest, or hypoxemic respiratory failure. The presence of right ventricular overload on physical examination or electrocardiogram is an especially important clue. Depending on local expertise and the patient's stability, V/Q scanning, CT angiography, echocardiography, and right heart catheterization can be useful in establishing a diagnosis of pulmonary embolism. Supportive treatment includes oxygen, vasoactive medicines, and sometimes fluids. Although heparin is important in nearly all patients, 70% to 80% of patients also require an IVC filter, thrombolysis, or embolectomy.
Gossage
James R
JR
Department of Medicine, Medical College of Georgia School of Medicine, Section of Pulmonary and Critical Care Medicine, BBR-5513, 1120 15th St, Augusta, GA 30912-3135, USA. jgossage@mail.mcg.edu
D000465:Algorithms; D003952:Diagnostic Imaging / Q000379:methods; D017128:Embolectomy; D006801:Humans; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D014218:Triage / Q000379:methods