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Treatment of massive pulmonary embolism

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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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