Treatment of massive pulmonary embolism
The patient should be immediately actively resuscitated, according to the degree of cardiorespiratory insufficiency:
- administration of 100% oxygen by mask or endotracheal intubation
- intravenous fluids may to maintain right-sided filling pressures and venous return
- inotropic agents and correction of acidosis may be required
- a bolus of 10,000 units of IV heparin should be given
- in extreme circumstances external cardiac massage may be used; this may result in embolus fragmentation
The patient may require immediate embolectomy. Otherwise, if the patient survives the initial cardiorespiratory insult and is stable, thrombolysis should be considered.
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