Current Controversies in Caring for the Critically Ill Pulmonary Embolism Patient

Emerg Med Clin North Am. 2020 Nov;38(4):931-944. doi: 10.1016/j.emc.2020.06.012. Epub 2020 Aug 12.

Abstract

Emergency physicians must be prepared to rapidly diagnose and resuscitate patients with pulmonary embolism (PE). Certain aspects of PE resuscitation run counter to typical approaches. A specific understanding of the pathophysiology of PE is required to avoid cardiovascular collapse potentially associated with excessive intravenous fluids and positive pressure ventilation. Once PE is diagnosed, rapid risk stratification should be performed and treatment guided by patient risk class. Although anticoagulation remains the mainstay of PE treatment, emergency physicians also must understand the indications and contraindications for thrombolysis and should be aware of new therapies and models of care that may improve outcomes.

Keywords: Deep venous thrombosis; Pulmonary embolism; Thrombolysis; Venous thromboembolism.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Biomarkers / blood
  • Computed Tomography Angiography
  • Critical Illness
  • Echocardiography
  • Electrocardiography
  • Emergency Service, Hospital
  • Extracorporeal Membrane Oxygenation
  • Fluid Therapy
  • Humans
  • Intubation, Intratracheal
  • Lactic Acid / blood
  • Mechanical Thrombolysis
  • Natriuretic Peptide, Brain / blood
  • Nitric Oxide / therapeutic use
  • Oxygen Inhalation Therapy
  • Peptide Fragments / blood
  • Point-of-Care Systems
  • Positive-Pressure Respiration
  • Pulmonary Embolism / classification
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / physiopathology
  • Pulmonary Embolism / therapy*
  • Resuscitation / methods
  • Risk Assessment
  • Severity of Illness Index
  • Thrombolytic Therapy
  • Troponin / blood
  • Vasoconstrictor Agents / therapeutic use

Substances

  • Anticoagulants
  • Biomarkers
  • Peptide Fragments
  • Troponin
  • Vasoconstrictor Agents
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Nitric Oxide
  • Lactic Acid