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Treatment of massive pulmonary embolism

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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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