Emergency care for pulmonary thromboembolism algorithm of action

the acute, fulminant form of pulmonary embolism with a picture of asphyxia and cardiac arrest requires urgent resuscitation: intubation of the trachea and ventilation, closed cardiac massage and all activities carried out in case of sudden cardiac arrest.

Thrombolysis using streptokinase, uricinase, tissue plasminogen activators or plasminogen streptokinase complex is currently considered the most effective treatment for patients with massive pulmonary embolism.

It is believed that thrombolytic therapy may be an alternative to surgical treatment.

The acute form of pulmonary embolism, complicated by reflex collapse or shock, requires intensive infusion therapy at the prehospital stage: intravenous administration of 100-150 ml of reopoliglyukin (perfusion rate of 20 ml / min), 1-2 ml of a 0,2% solution of norepinephrine in 250 ml of 0,9 % solution of sodium chloride or reopoliglyukin with an initial speed of 10-15 drops / min (in the future, the rate of administration depends on the level of blood pressure and heart rate).

In the absence of a tendency and stabilization of blood pressure and the presence of high peripheral resistance, dopamine is administered intravenously (at a dose of 50 mg per 250 ml of a 5% glucose solution, the initial rate of administration is 15-18 drops / min). At the same time as these measures, 180 mg of prednisone or 300-400 mg of hydrocortisone, heparin (at a dose of 10 units), strophanthin (at a dose of 000 ml of a 0,50,75% solution), potassium preparations are administered intravenously. mandatory oxygen therapy.

With severe pain, the intravenous use of fentanyl (at a dose of 1-2 ml) with 2 ml of a 0,25% droperidol solution (with hypotension – 1 ml) is recommended; instead of fentanyl, omnopon can be used; a combination of analgin with promedol is also used. In the absence of hypotension, the administration of aminophylline is indicated (at a dose of 15 ml of a 2,4% solution on reopoliglukin, intravenously, drip). Antiarrhythmic therapy is indicated.

Treatment of subacute and recurrent forms of pulmonary embolism, usually occurring with a clinic of heart attack pneumonia, includes the use of anticoagulants (heparin, indirect anticoagulants) and antiplatelet agents, as well as antibiotics. According to indications, aminophylline, oxygen therapy, antiarrhythmic drugs are used.

In patients with acute and acute form of pulmonary embolism, emergency care at the prehospital stage should be provided by a specialized cardiological team (Fig. 2, c). Bypassing the admission department, the patient is delivered to the cardiopulmonary resuscitation department, where the thrombolytic and anticoagulant therapy started at the prehospital stage continues, as well as the fight against cardiovascular and respiratory failure. In the absence of the effect of conservative therapy, they resort to surgical treatment (embolectomy, etc.).

For prophylactic purposes (with recurrent forms of pulmonary embolism), they are treated with anticoagulants and antiplatelet agents, as well as surgical interventions on the veins (ligation, partial occlusion of the main vein, the introduction of “umbrellas” into the inferior vena cava, etc.).

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.