CAGE FIGHT - Should be thrombolyse submassive PE CON

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Some of the most difficult topics in medicine attract considerable debate, The use of thrombolysis for submassive PE is one of these. In this "Con" argument I attempt to highlight some of the most pertinent evidence against the use of thrombolysis.

Health & Medicine

Should we Thrombolyse Patients
with Submassive PE in the
Emergency Department?
Dr Iain D M Beardsell MBChB FRCEM
Consultant in Emergency Medicine and Prehospital Emergency Medicine
University Hospital Southampton
UK

What is A Pulmonary Embolism?
• Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has traveled from
elsewhere in the body through the bloodstream (embolism).[1] Symptoms may include shortness of breath,
chest pain particularly upon breathing in, and coughing up blood.[2] Symptoms of a blood clot in the leg may
also be present such as a red, warm, swollen, and painful leg.[2] Signs include low blood oxygen levels, rapid
breathing, rapid heart rate, and sometimes a mild fever.[3] Severe cases can lead to passing out, abnormally
low blood pressure, and sudden death.[4]
• PE usually results from a blood clot in the leg that travels to the lung.[1] The risk of blood clots is increased by
cancer, prolonged bed rest, smoking, stroke, certain genetic conditions, pregnancy, obesity, and after some
types of surgery.[5] A small proportion of cases are due to the embolization of air, fat, or amniotic fluid.[6][7]
Diagnosis is based on signs and symptoms in combination with test results. If the risk is low a blood test
known as a D-dimer may rule out the condition. Otherwise a CT pulmonary angiography, lung
ventilation/perfusion scan, or ultrasound of the legs may confirm the diagnosis.[8] Together deep vein
thrombosis and PE are known as venous thromboembolism (VTE).[9]
• Efforts to prevent PE include beginning to move as soon as possible after surgery, lower leg exercises during
periods of sitting, and the use of blood thinners after some types of surgery.[10] Treatment is typically with
blood thinners such as heparin or warfarin.[11] Often these are recommended for six months or longer.[12]
Severe cases may require thrombolysis using medication such as tissue plasminogen activator (tPA), or may
require surgery such as a pulmonary thrombectomy. If blood thinners are not appropriate a vena cava filter
may be used.[11]

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PULMONARY EMBOLISM- Venous Diseases • Dear Viewers, • Greetings from “Surgical Educator” • Today I have uploaded a video on Pulmonary Embolism-PE. • In this video, I discussed about the etio-pathogenesis, clinical features, investigations, Wells scoring, differential diagnosis, treatment and treatment algorithm of Pulmonary Embolism. • I hope you will enjoy the video. • You can watch all my teaching videos in the following links: • surgicaleducator.blogspot.com youtube.com/c/surgicaleducator • Thank you for watching the video

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