Lytics in the Sick PE Patient

In this lecture from ResusX: Reset (see link below for more lectures), Dr. Scott Weingart delves into the complexities of treating sick pulmonary embolism (PE) patients, emphasizing the need for a more nuanced approach than the traditional stable, submassive, and massive categories.
He proposes expanding to five categories, including stable, not sick submassive, sick submassive, not super sick massive, and super sick massive, to guide treatment decisions better. Dr. Weingart highlights the importance of risk stratification using vital signs, clot size, and other markers like lactate and troponin levels.
For sick submassive patients with low bleeding risk, he advocates for a lower dose of fibrinolysis-specifically, 25 mg of Alteplase over six hours-as a safe and effective option. He underscores that the severity of PE and bleeding risk should dictate the fibrinolytic dose, aiming for precise and individualized patient care.
00:00 Introduction and Overview of PE Management
00:15 The Need for More Detailed Categorization
01:10 Defining the Six Categories of PE
02:39 Risk Stratification and Initial Assessment
03:21 Understanding Submassive PE
03:56 Sick Submassive PE: Criteria and Management
05:09 Scoring Systems: sPESI vs. Bova
06:16 Fibrinolysis in Sick Submassive PE
07:52 Case Study: Reduced-Dose Fibrinolysis
10:20 Management of Massive PE
12:27 Peri-Code and Coding Patients
13:30 Summary and Final Thoughts
To watch more videos from the ResusX conference, check out www.resusx.com/offers/bwjtxAHf
#EmergencyMedicine, #CriticalCare, #PulmonaryEmbolism, #PEManagement, #Fibrinolysis, #ScottWeingart, #ResusX, #SubmassivePE, #MassivePE, #Alteplase, #Tenecteplase, #EMCrit, #ShockIndex, #RiskStratification, #LowDoseFibrinolysis

[@davidpecora7750]

Great stuff. Thanks!

[@farhanqadeer82]

great talk , question lots of time before we give tPA patient is already on Heparin ( would you start TPA even if they are therapeutic, wondering what protocol do you follow) ,, 2. if someone is on Eliquis and has eliquis failure will you consider TPA if they are sick submassive or massive 3. After TPA when do you start AC (Heparin gtt)

[@nonfaker]

Good questions imo.
Nr. 2 (maybe even the nr. 1) is answered in the moderate bleeding risk box, as anticoagulation is one of those criteria