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5 335
Severe Pulmonary Embolysm + Shock :
SBP < 90mmHg
Management :
1. Unfractionated heparin 60UI/kg Bolus , then continuous intravenous infusion ; monitor anti Fac Xa
2. Thrombolysis with Alteplase 10mg in 2 mins , then 90mg in 2 hrs
3. Post-thrombolysis for Pulmonary embolysm, continuous iV Unfractionated heparin is ideal,
NOT LMWH nor Fondaparinux
4. if fibrinolysis is contraindicated or if shock persist => surgical or endovascular embolectomy.
