Here’s Dr. DiMare with another Morning Report!
Fibrinolytics for Suspected PE in Cardiac Arrest
tPA in cardiac arrest seems like a great idea
– 81% are from MI and PE
– only 2-10% survival in out of hospital arrest
When should you give it?
– Current literature is favorable only in patients with known PE
– BUT. . . ACLS guidelines say its ok in presumed PE…
– What should make us think PE above other causes such as MI?
- Bedside echo? If you have ROSC long enough to take a look
- Based on rhythm? More likely PEA and asystole
- Labs? Profound lactic acidosis
- EKG? R heart strain
– “Not enough evidence to support routine use in undifferentiated cardiac arrest…”
Whats the dose? How should you give it?
What happens next?
– continue CPR for 15-30 minutes
– consider a 2nd bolus dose of 50mg
– heparin should be started
- LMW vs UF?
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
Latest posts by Jay Khadpe MD (see all)
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