TY - CHAP M1 - Book, Section TI - Pulmonary Embolic Disorders: Thrombus, Air, and Fat A1 - Meyer, Nuala J. A1 - Schmidt, Gregory A. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - Pulmonary embolism (PE) is common and potentially lethal, yet readily treatable.Prophylaxis and accurate diagnosis are essential to improving outcome.The cause of death in PE is most often circulatory failure (acute cor pulmonale) due to right heart ischemia.There is no perfect diagnostic test for PE; accurate diagnosis requires both an informed clinical pretest probability and a stepwise application of helical CT angiography and/or LE duplex.A careful risk assessment may identify patients ideal for outpatient therapy. Conversely, patients with hypotension or right ventricular strain are at significantly higher risk for death from PE, and warrant ICU admission.While low-molecular-weight heparin (LMWH) is approved and recommended as the initial therapy for PE, critically ill patients often have reason for a shorter-acting medication. Unfractionated heparin is typically used to maintain the partial thromboplastin time (PTT) at 1.5 to 2.5 times control.Thrombolytic therapy is lifesaving and possibly in those with isolated RV dysfunction in patients with massive embolism and circulatory instability, but does not seem beneficial in patients without shock.Air and fat embolism usually present as acute respiratory distress syndrome (ARDS), and are managed with mechanical ventilation, oxygen, and positive end-expiratory pressure (PEEP). SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/04 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1107717555 ER -