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Massive pulmonary embolism with shock: role of thrombolysis using central venous access Journal Article

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Authors:	Pillarisetti, Jayasree; Gupta, Kamal
Article Title:	Massive pulmonary embolism with shock: role of thrombolysis using central venous access
Alternate Title:	The Journal of invasive cardiology
Journal Title:	The Journal of invasive cardiology
Volume:	24
Issue:	12
ISSN:	1557-2501
Publisher:	HMP Communications
Date Published:	2012
Start Page:	E321
End Page:	324
DOI/URL:	http://www.ncbi.nlm.nih.gov/pubmed/23220994
Notes:	BACKGROUND: Massive pulmonary embolism (PE) complicated with shock has an extremely high mortality rate with medical treatment. Since access to emergency vascular surgery or endovascular specialists is not readily available in most centers, patients are frequently treated with thrombolytic agents delivered via a peripheral venous access. Patients with shock, however, have poor peripheral perfusion, and peripheral administration of thrombolytic agents may thus not reliably deliver the agent to the embolus, reducing treatment efficacy. OBJECTIVE: This report discusses the role of thrombolysis administered via central venous access in PE with shock. CASE REPORT: This report describes the case of a 46-year-old man presenting with new-onset atrial fibrillation, right bundle branch block, and shock from a massive PE. In view of shock, thrombolytics were given via a subclavian central venous catheter. He improved dramatically within 1 hour, with prompt resolution of the shock and the dysrhythmia.

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