Algorithms
Emergencies
Massive Pulmonary Embolism
High-risk PE with shock or arrest needs reperfusion: systemic thrombolysis unless contraindicated, otherwise surgical or catheter therapy.
Interactive pathway
- Assess
Suspect PE
- Sudden dyspnea, pleuritic pain, syncope, hypoxia, shock
- Risk factors: surgery, immobility, malignancy, OCP/pregnancy, prior VTE
- ECG: sinus tach, S1Q3T3, RBBB, TWI V1–V4
- Action
Resuscitate the RV
- O₂ (avoid intubation if possible: induction and PPV can cause collapse)
- Cautious fluids (≤ 500 mL); volume worsens RV failure
- Norepinephrine for hypotension
- Bedside echo: RV dilation, McConnell sign, D-sign
- Decision
Cardiac arrest?