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Submassive Massive PE - EMCrit Project If a patient with known submassive massive PE develops ST elevation, this is most likely due to the PE itself Treatment should generally focus on management of the PE Don't make the mistake of assuming that all patients with ST elevation require a cardiac catheterization – in the context of known (sub)massive PE, sending the patient for
Management of Massive and Submassive Pulmonary Embolism, Iliofemoral . . . Outcomes in acute PE vary substantially depending on patient characteristics 4,5 To tailor medical and interventional therapies for PE to the appropriate patients, definitions for subgroups of PE are required The qualifiers “massive,” “submassive,” and “nonmassive” are often encountered in the literature, although their definitions are vague, vary, and lead to ambiguity 6
Management of massive and nonmassive pulmonary embolism Fibrinolytic therapy for massive pulmonary embolism Thrombolytic therapy causes rapid lysis of clot and more rapid improvement in RV hemodynamics Thrombolytic therapy is recommended as standard, first-line treatment in patients with massive PE, unless contraindicated As noted earlier, the majority of patients with acute PE and cardiogenic
Management of PE - American College of Cardiology Treatment Anticoagulation should be initiated as soon as the diagnosis of PE is suspected 8 Unfractionated heparin may be preferred in patients who are candidates for further advanced therapies such as thrombolysis, catheter-directed thrombolytics or embolectomy, or surgical embolectomy because it provides more flexibility for procedures 4 Direct oral anticoagulants are first-line therapy
Massive Pulmonary Embolism - American Thoracic Society 23 McCotter CJ et al Intrapulmonary artery infusion of urokinase for treatment of massive pulmonary embolism: a review of 26 patients with and without contraindications to systemic thrombolytic therapy Clin Cardiol 1999; 22: 661-4 24 Kucher, N Catheter embolectomy for acute pulmonary embolism Chest 2007; 132: 657-663 25
Ask the Experts: What Is Your Treatment Algorithm for Massive Pulmonary . . . Acute high-risk (massive) pulmonary embolism (PE) is a life-threatening entity with an associated mortality as high as 65% 1 Defined as acute PE with sustained hypotension (systolic blood pressure [SBP] < 90 mm Hg for > 15 minutes) and or requiring vasopressor support, high-risk PE is triaged and treated emergently due to significant morbidity and mortality
Eight pearls for the crashing patient with massive PE - EMCrit Project Mercat 1999 described 13 patients with submassive PE who were challenged with 500 ml of dextran Although the study refers to these patients as having “massive PE,” this is based on a cardiac index <2 5 rather than clinical criteria These patients had an average mean arterial pressure of 101mm and patients requiring inotropes were excluded, suggesting that most subjects would clinically
Management of Massive Pulmonary Embolism | Circulation - AHA ASA Journals The principal criteria for categorizing PE as massive are arterial hypotension and cardiogenic shock Arterial hypotension is defined as a systolic arterial pressure <90 mm Hg or a drop in systolic arterial pressure of at least 40 mm Hg for at least 15 minutes 3 Shock is manifested by tissue hypoperfusion and hypoxia, including an altered level of consciousness, oliguria, or cool, clammy
What Is Your Treatment Algorithm for Massive Pulmonary Embolism? Time is of the essence in high-risk PE, and management of high-risk massive PE requires a multifaceted approach The PERT—usually comprising emergency medicine, pul-monary critical care, interventional cardiology, interven-tional radiology, and hematology—should be consulted as soon as massive PE is suspected (Figure 1) The PERT assists