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.