Dr. Feras Khan is an emergency medicine trained intensivist who has recently joined the University of Maryland’s departments of both CCM and EM. This is a great lecture on the nuts and bolts of managing the patient with an acute PE in the ICU. Do you know the code dose of t-PA if that PE patient decompensates? Who should be given low-molecular weight heparin (LMWH) vs. unfractionated heparin (UFH)? Who gets an IVC filter? Well, for some of these questions you may only have a minute or two to decide – so if you aren’t sure, take 30 minutes out of your day and get some quality core-content education.
- Sustained hypotension defined as a SBP < 90 is an indication for PE thrombolysis. How long is sustained hypotension? 15 Minutes.
- The risk of hemorrhagic complications secondary to PE thrombolysis is estimated to be about 20%. ICH post t-PA for pulmonary embolism appears to be around 1-5%.
- In patients admitted to the ICU, strongly consider UFH over LMWH for anticoagulation therapy. Specifically use UFH if the patient has any evidence of renal insufficiency/failure, BMI>40, or even a chance that they will need thrombolytics or surgical intervention (i.e. most ICU patients).
If you haven’t read the MOPETT Trial yet, do yourself a favor and invest at least 30 minutes in reading through this study. It may be a practice changing article.
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