Pulmonary Embolism: Treatment

by Carlo Raj, MD

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    00:01 Now, treatment. Anticoagulation is the name of the game.

    00:06 IV heparin or what was the name of that low molecular type of heparin that we talked about? Good. And that was in fact your enoxaparin, make sure you know the name.

    00:16 Well, by a long-term Coumadin. What's Coumadin mean? Warfarin.

    00:19 Why don't you give that first? Cuz your patient would be dead.

    00:24 So what's the point of saving a dead patient, right? You get my point.

    00:28 Warfarin takes a long time for it to work where inhibition of epoxide reductase from the liver, so you give that long term.

    00:33 Not to mention, you can't go home and give yourself IV heparin. All right? Don't do that.

    00:38 Now, patients should receive thrombolytic therapy if they're hemodynamically unstable.

    00:43 So what does that mean to you? Are you looking for issues where the patient basically has massive hypotension, unstable secondary to massive emboli? So only thing is, you wanna then - be careful with using thrombolytics because contraindication's the biggest one of them.

    00:59 Would be one in, which may be your patient has a bleeding disorder. Okay? Maybe it's something Von Willebrand disease or something like hemophilia or maybe perhaps even, there is a hemorrhagic stroke and such, so be careful with that.

    01:12 I do need to state that quite and make - place emphasis on contraindications for thrombolytic therapy.

    01:19 You at this point with questions, need to abide by them.

    01:24 In clinical practice, you do what you want but for now, make sure you abide by the thrombolytic contraindications I gave you a couple where the patient might be bleeding or might be at risk for hemorrhagic stroke.

    01:37 Should see either hypotension or impeding right ventricular failure if you're thinking about a patient who maybe is hemodynamically unstable.

    01:47 Hypotension is huge and obviously, right ventricular hypertrophy may result in eventual failure.

    01:52 Now, can consider a filter replacement and you find many patients who are older and especially postoperatively after they go home.

    02:01 Now literally, they have an inferior vena cava.

    02:03 Filtered, think about that.

    02:05 So therefore, it's not going to - and I'll tell you this though, it's not a guarantee.

    02:09 So if you get a question where a patient has all the signs and symptoms, this is important, please pay attention.

    02:15 Your patient has all the signs and symptoms of PE; the shortness of breath, the hypoxemia, there is even the palpable cord and such. Okay? And you know, there's somewhere in there that it says that in the vignette, it tells you there was an inferior vena cava filter placed.

    02:31 There's no guarantee that's going to prevent PE. Is that clear? So that can be a little tricky, so be careful.

    02:38 It can prevent the massive embolization but the patient might still suffer from PE if he or she is prone to it.

    About the Lecture

    The lecture Pulmonary Embolism: Treatment by Carlo Raj, MD is from the course Disorders of the Pulmonary Circulation and the Respiratory Regulation.

    Included Quiz Questions

    1. Heparin, followed by warfarin
    2. Surgical embolectomy
    3. Warfarin only
    4. Thrombolysis
    5. IVC filter placement
    1. Hypotension and contraindications to thrombolytic therapy
    2. Contraindications to thrombolytic therapy and presence of IVC filter
    3. Age of patient and hypotension
    4. Contraindications to thrombolytic therapy and a palpable cord
    5. Hypotension and a palpable cord

    Author of lecture Pulmonary Embolism: Treatment

     Carlo Raj, MD

    Carlo Raj, MD

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