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Pulmonary embolism checklist

Initial management

• perform ABCDE assessment.
• provide analgesia and oxygen therapy as needed.
• Unstable patients (i.e., massive PE): Stabilize, obtain ECG, and consider bedside echocardiogram and empiric therapy based on bleeding risk.
• assess bleeding risk on anticoagulation for VTE.
• consider empiric anticoagulation if the bleeding risk is low.
• evaluate RV function to determine the severity of PE.
• consult PERT.

Nonmassive PE

• Low bleeding risk: Start anticoagulation with a DOAC or heparin.
• High bleeding risk: Consider IVC filter placement.
• Consider outpatient management; see “Risk stratification and disposition.”

Submassive PE

• Low bleeding risk: Start anticoagulation with UFH or LMWH.
• High bleeding risk: Consider IVC filter placement.
• Consider thrombolysis for PE in select patients, e.g., those with continued clinical deterioration.
• admit to ICU or telemetry.

Massive PE

• evaluate the need for mechanical ventilation.
• have a crash cart at the bedside.
• consider limited IV fluid therapy for hemodynamic support (e.g., 250-500 mL crystalloid fluid IV once).
• begin vasopressor infusion for hemodynamic support if needed.
• check for contraindications to thrombolysis for PE.
• no absolute contraindications: Initiate thrombolysis for PE.
• absolute contraindications: Consult interventional radiology and/or surgery to perform embolectomy for PE.
• continuous telemetry and pulse oximetry.
• transfer to ICU.