Management of high-risk pulmonary embolism in the emergency department: A narrative review.
Am J Emerg Med
; 79: 1-11, 2024 May.
Article
de En
| MEDLINE
| ID: mdl-38330877
ABSTRACT
BACKGROUND:
High-risk pulmonary embolism (PE) is a complex, life-threatening condition, and emergency clinicians must be ready to resuscitate and rapidly pursue primary reperfusion therapy. The first-line reperfusion therapy for patients with high-risk PE is systemic thrombolytics (ST). Despite consensus guidelines, only a fraction of eligible patients receive ST for high-risk PE.OBJECTIVE:
This review provides emergency clinicians with a comprehensive overview of the current evidence regarding the management of high-risk PE with an emphasis on ST and other reperfusion therapies to address the gap between practice and guideline recommendations.DISCUSSION:
High-risk PE is defined as PE that causes hemodynamic instability. The high mortality rate and dynamic pathophysiology of high-risk PE make it challenging to manage. Initial stabilization of the decompensating patient includes vasopressor administration and supplemental oxygen or high-flow nasal cannula. Primary reperfusion therapy should be pursued for those with high-risk PE, and consensus guidelines recommend the use of ST for high-risk PE based on studies demonstrating benefit. Other options for reperfusion include surgical embolectomy and catheter directed interventions.CONCLUSIONS:
Emergency clinicians must possess an understanding of high-risk PE including the clinical assessment, pathophysiology, management of hemodynamic instability and respiratory failure, and primary reperfusion therapies.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Embolie pulmonaire
/
Traitement thrombolytique
Type d'étude:
Etiology_studies
/
Guideline
/
Qualitative_research
/
Risk_factors_studies
Limites:
Humans
Langue:
En
Journal:
Am J Emerg Med
Année:
2024
Type de document:
Article