1. Prehospital Care:
- The most important thing that can be done in the prehospital setting is to transport the patient to a hospital.
- Oxygen always should be started in the prehospital phase, and an IV line should be placed if it can be accomplished rapidly without delaying transport.
2. Emergency Department Care:
- Fibrinolytic therapy has been the standard of care for patients with massive or unstable pulmonary embolism since 1970s.
* Fibrinolysis may be considered for any patient with PE who lack specific contraindications to the therapy.
- Oxygen should be administered to every patient with suspected PE, even when the arterial PO2 is perfectly normal, because increased alveolar oxygen may help to promote pulmonary vascular dilatation.
- IV fluids may help or may hurt the patient who is hypotensive from PE depending on which point on the Starling curve describes the patient’s condition.
* A Swan-Ganz catheter is helpful to determine whether a fluid bolus is indicated.
* Improvement or normalization of blood pressure after fluid loading does not mean the patient has become hemodynamically stable.