Workup

• Trop and BNP
• INR, PTT, Dimer, lactate
• CTPE and echo
• Shock index (HR/SBP)> 1: indicates poor prognosis
• Watch for bradycardia: extremely worrisome sign and indicates impending brady-asystolic arrest

Treatment

• Do not give fluids! Even if hypotensive the hypotension and shock in PE is due to RV dilation into the LVOT causing an LVOT obstruction, so if you give fluids this will worsen the LVOT obstruction and shock
• If pressers required epinephrine is 1st line for inotropy

If high risk with hemodynamic instability

• TPA--> 100mg alteplase
• Call PERT team--> Potential for Inari or EKOS

Intermediate Risk

• Unfractionated heparin-> load 5,000 units and then drip at 18u/kg/hr
• Call PERT team: may decide indication for Inari or EKOS on case by case basis

Low risk

• Case by case basis, many can be started on a DOAC and treated outpatient

Inari Flowtriever

EKOS- Catheter directed TpA + ultrasound