A 56 y/o male is found in cardiac arrest by his wife. She calls 911. CPR is initiated. Pulseless electrical activity (PEA) is the only rhythm throughout the resuscitation. Finally, ROSC is achieved and the patient is placed on norepinephrine at 30mcg/min, epinephrine at 30 mcg/min and vasopressin at 0.04 U/min.
POCUS shows a dilated right ventricle and empty left ventricle. CTPA shows large pulmonary embolism (PE). 50 mg tenecteplase (TNK) is given over 1-2 hours and the pressors are down titrated. Unfortunately, the patient had a poor neurologic outcome and the family withdrew care.
Take Away #1:Risk Stratify Patients with Possible PE