#RAVENEL BRIDGE SUSPICIOUS PACKAGE CODE#
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Recently, multidisciplinary PE response teams (PERT teams) have become popular as a strategy to handle this disorder. If we split patients apart on the basis of severity, then it becomes difficult to recruit a large enough population to study with statistical power.If we lump patients with different severity together, then results become difficult to interpret (perhaps the study intervention is helping some patients within the cohort, but not others).This is a prime example of the lumping-vs-splitting paradox common in researching many critical illnesses: Given that PE is a heterogeneous and emergent condition, it should come as no surprise that our evidence basis is far from complete. To complicate matters further, patients can evolve rapidly in one direction or the other. This is a highly heterogeneous disease, spanning the gamut from patients who are doing pretty well to patients who are profoundly ill.

Interventional radiology clot extraction (e.g.

Other PE-directed therapies (tPA failure/contraindication)

Relative contraindication & stabilized: may start with 50 mg alteplase.

Relative contraindication & actively dying: 50-100 mg alteplase.

If no immediate access to epoprostenol or nitric oxide, use 5 mg nebulized nitroglycerine.

#RAVENEL BRIDGE SUSPICIOUS PACKAGE PLUS#

If refractory may consider combination of nitric oxide plus epoprostenol.Epoprostenol or nitric oxide вЂ“ whatever you can get fastest.Epinephrine is the preferred front-line agent, titrate for MAP > 65 mm.DonвЂ™t give fluid unless evidence of low filling pressure (e.g., small IVC or collapsed jugular veins).Fluid is rarely helpful (venous pressure generally already excessively high).benefit massive PE: resus вњ… fluid-conservative strategy ( more) Neutrophil/lymphocyte ratio (9.2 is worrisome 5.5-9.2 is a grey zone).Д«alancing risk vs.Contrast reflux into the inferior vena cava on CT scan.RV dilation on CT scan or echocardiography.RBBB or SI-QIII-TIII (both have OR of ~2).

Hypotension caused by PE (SBP 40 mm for 15 minutes, requirement for vasopressors).

Risk stratification вЂ“ bits to consider вњ… hemodynamic instability

Lactate (ideal, but not mission-critical).

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#RAVENEL BRIDGE SUSPICIOUS PACKAGE CODE#

вЂ¦ cardiac arrest (how to code a PE patient).

Some unusual & confusing situations: Submassive or massive PE plusвЂ¦.

Risk stratification & lysis without a CT scan.

Prognostic factors which don't add much.

Is PE driving the patient's instability?.

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