title: Massive pulmonary embolism with shock: role of thrombolysis using central venous access.
abstract: BACKGROUND
  Massive pulmonary embolism (PE) complicated with shock has an extremely high mortality rate with medical treatment. Since access to emergency vascular surgery or endovascular specialists is not readily available in most centers, patients are frequently treated with thrombolytic agents delivered via a peripheral venous access. Patients with shock, however, have poor peripheral perfusion, and peripheral administration of thrombolytic agents may thus not reliably deliver the agent to the embolus, reducing treatment efficacy.
  
  
  OBJECTIVE
  This report discusses the role of thrombolysis administered via central venous access in PE with shock.
  
  
  METHODS
  This report describes the case of a 46-year-old man presenting with new-onset atrial fibrillation, right bundle branch block, and shock from a massive PE. In view of shock, thrombolytics were given via a subclavian central venous catheter. He improved dramatically within 1 hour, with prompt resolution of the shock and the dysrhythmia.
authors.affiliation: Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City, KS 66209, USA. jayasreep24@gmail.com
authors.forename: Jayasree
authors.initials: J
authors.lastname: Pillarisetti
authors.forename: Kamal
authors.initials: K
authors.lastname: Gupta
mesh_terms: D001281:Atrial Fibrillation / Q000209:etiology; D002037:Bundle-Branch Block / Q000209:etiology; D062905:Central Venous Catheters; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications* / Q000188:drug therapy*; D012769:Shock / Q000209:etiology*; D013350:Subclavian Vein; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents