Critical PE Management Pearls
Thanks to Liz Cho for a nicely presented case of a PE sudden death and lit review of thrombolytics in PE and arrest.
For those of you who missed, (and you know who you are):
Heparin lives in the ED, and can be given IV immediately (Order>nurse> patient).
Lovenox takes a while. (Order,>nurse> tube> pharmacy (who sends it back for dosing adjustment)> tube > BA> nurse> patient)
The literature supports thrombolysis in PE/ shock.
10% of hemodynamically stable patients with RV dysfunction will deteriorate into shock with 50% mortality rate
Patients with RV dysfunction have mortality rate of 9.3% compared with 0.4% with normal RV function.
If you think a patient has RV dysfunction and are considering thromboytics, look at the RV.
Signs of RV dysfunction are RV distention or hypokinesis, paradoxical RV septal systolic motion, RV larger than LV in subcostal or apical view
If you are uncomfortable (most of us may be) evaluating for RV dysfunction, call for echo.
Cardiology has committed to 24/7 cardiac echo; call them if the answer will change your treatment (i.e. thrombolytics).
Consider thrombolytics if suspicion is high for PE as opposed to a bleeding pathology, such as dissection. Thrombolytics in undifferentiated cardiac arrest have not been shown to improve outcome.
Posted
on Thursday, January 28th, 2010 at 2:57 pm by Lisa. Filed under
Pulmonary Embolism, Blog.
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