Paper Chase 4 – Lysis for PE in PEA

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Nurses Edition Commentary

Sanjay Arora, MD and Mike Menchine, MD
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Vanessa C. -

So I have a question which I guess is not going after your scientific answer but is more of mini poll of what would you do in this situation... you are in a emote small hospital with no imaging available other than X-ray and POCUS. Probably 6-8 hours before you can get someone to a scan. A dyspneic patient comes in pre-arrest and you have time to ultrasound him. See signs that suggest possible PE, maybe you have time to look at his legs and you find a DVT. He arrests. PEA. Would you try the tpa at some point or not at all? If so where in the algorithm would you throw it in? And now what if the patient came in after they arrested. CPR in progress. PEA. Nothing else working, would you try the tpa as last ditch effort? I realize that this isn't what the study was looking at but in my practice location we sometimes have to improvise and extrapolate... just interested in you thoughts.

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