EMedHome's Clinical Pearl
Thrombolysis is associated with improved rates of returnof spontaneous circulation and neurologically-intact survival in cardiac arrest from pulmonary embolism. (J Intensive Care Med. 2019;34:603; Circulation. 2015;132[18 Suppl 2]:S501, http://bit.ly/2TLbsRI; Crit Care Med. 2001;29:2211.) Early use is also associated with improved outcome in cardiac arrest, but there is no consensus about the optimal agent or dosing regimen.
Current recommendations are either the standard weight-based dose of TNK (30-50 mg) or a 50 mg tPA bolus that can be repeated in 15 minutes if there is no ROSC. (J Intensive Care Med. 2019;34:603; Circulation. 2015;132[18 Suppl 2]:S501; http://bit.ly/2TLbsRI.)
The drug's effect is not immediate, so CPR may need to be continued for some time after administration depending on the clinical context, although the duration is controversial. (J Intensive Care Med. 2019;34:603; Circulation. 2015;132[18 Suppl 2]:S501, http://bit.ly/2TLbsRI; Resuscitation. 2015;95:148; http://bit.ly/30hFnn2.) The European Resuscitation Council Guidelines recommend continuing CPR for at least 60 to 90 minutes after thrombolysis before terminating resuscitation. (J Intensive Care Med. 2019;34:603; Resuscitation. 2015;95:148; http://bit.ly/30hFnn2.)
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Matthew R. Levine, MD: Easy-to-Overlook Orthopedic Injuries: http://bit.ly/EMN-EMedHomeVideos. Dr. Levine is an assistant professor of emergency medicine and the director of trauma services at Northwestern Memorial Hospital in Chicago.
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Amal Mattu, MD, and Colleagues: The Crashing Obese Patient, Magnesium For Atrial Fibrillation, Post-Arrest Cardiac Catheterization, and Difficult Airway Assessment: http://bit.ly/MattuEMN. Dr. Mattu is one of the premier speakers in emergency medicine, and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.