Responding to Life-Threatening Pulmonary Embolic Disease

摘要

Why is there so much institutional variation in the management of pulmonary embolic disease? Despite being the "most preventable cause of death among hospitalized patients," pulmonary embolic disease (PED) still manages to claim 100,000 to 180,000 lives a year in the United States. A recent "Top Paper" defined "massive" (5%) and "submassive" PED (20% to 25%).These 2 categories of PED, complicated by hypotension, syncope, cardiogenic shock, cardiac arrest (massive), and right ventricular (RV) dysfunction (submassive), are life-threatening. The information in the Top Paper, focusing on the submassive variety, is timely and should significantly change future practice.The paper was organized according to the JAMA "Clinical Crossroads, Conferences with Patients and Doctors" format. It began with a case presentation, followed by pertinent questions, pathophysiology, diagnostic insights, therapy, specific recommendations for the patient presented, and final questions with discussion. The following are important points in the paper (definitely not all inclusive).