Critical Care Case Studies

Rotatable pigtail catheter [20]: The pigtail tip of this catheter (Cook Europe; Bjaeverskov, Denmark) is rotated either by hand or by an attachable low-speed electric catheter to disrupt the intrapulmonary clot into smaller fragments which then migrate into the distal pulmonary circulation.

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Findings on Doppler echocardiogram demonstrate acute right ventricular pressure overload Echocardiographic findings may also help to distinguish the chronicity of events in patients with massive pulmonary embolus, which may be of clinical relevance regarding therapy [3].

One study in humans [14], however, suggested that a 500 ml fluid load may initially improve cardiac output among patients with massive PE, although the long-term effects of fluid administration on cardiac function and hemodynamics are unclear.

Most authors would agree that intravenous fluids must be used with caution in patients with massive PE [15-17].

FIGURE 1: CT scan of the chest demonstrating pulmonary emboli in bilateral main pulmonary artery What distinguishes massive from submassive pulmonary embolism?

Anticoagulation was initiated and the patient was transferred to the intensive care unit (ICU) for further management.

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