यह प्रोटोकॉल उच्च-जोखिम तीव्र पल्मोनरी एम्बोलिज्म को कवर करता है जो हेमोडायनामिक अस्थिरता द्वारा विशेषता है — नीचे दिए गए एक या अधिक नैदानिक मानदंडों द्वारा परिभाषित एक गंभीर प्रस्तुति।
उपचार का उद्देश्य हाइपोक्सेमिया (धमनी ऑक्सीजन संतृप्ति ≥90%) को ठीक करना, हेमोडायनामिक स्थिरता (सिस्टोलिक रक्तचाप ≥90 mmHg) को बहाल करना, और 36 घंटों के भीतर इकोकार्डियोग्राफी पर दाएं वेंट्रिकुलर डिसफंक्शन के समाधान को प्राप्त करना है।
References
DOI: 10.1093/eurheartj/ehz405
High-risk PE is defined by haemodynamic instability and encompasses the forms of clinical presentation shown in Table 4.
Need for cardiopulmonary resuscitation
Systolic BP < 90 mmHg or vasopressors required to achieve a BP ≥90 mmHg despite adequate filling status
End-organ hypoperfusion (altered mental status; cold, clammy skin; oliguria/anuria; increased serum lactate)
Systolic BP < 90 mmHg or systolic BP drop ≥40 mmHg, lasting longer than 15 min and not caused by new-onset arrhythmia, hypovolaemia, or sepsis
It is recommended that anticoagulation with UFH, including a weight-adjusted bolus injection, be initiated without delay in patients with high-risk PE.
Systemic thrombolytic therapy is recommended for high-risk PE.
Accelerated i.v. administration of recombinant tissue-type plasminogen activator (rtPA; 100 mg over 2 h) is preferable to prolonged infusions of first-generation thrombolytic agents (streptokinase and urokinase).
Norepinephrine and/or dobutamine should be considered in patients with high-risk PE.
Administration of supplemental oxygen is indicated in patients with PE and SaO2 <90%.
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