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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.

Adult onset diabetes