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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

George Schiffman, MD, FCCP

George Schiffman, MD, FCCP

Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.

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Pulmonary Embolism Treatment

Pulmonary Embolism Medical Treatment

When a person goes to a hospital's emergency department or a doctor's office with chest pain or other symptoms that may suggest a pulmonary embolism, remember that the diagnosis has not yet been confirmed, and therefore not all treatment will occur from the beginning of an evaluation.

Patients with chest pain will be placed on a heart monitor, and usually an IV will be inserted, labs drawn and an electrocardiogram (EKG, ECG) ordered.

Some people with pulmonary embolism are critically ill. They have severe shortness of breath, low blood pressure, and low oxygen concentrations. Much more aggressive treatment is undertaken to support or elevate the blood pressure and increase the oxygen in the blood.

The following treatments are the most frequently used for pulmonary embolisms.

• Oxygen can be given in several ways. One is through tubing that is inserted at the tip of the nostrils, called a nasal cannula.
• If the patient has severely low oxygen levels, he or she will be given a higher flow of oxygen through a mask.
• Patients may be so short of breath that they require ventilator treatment. A large tube is placed into the trachea (windpipe) and connected to a ventilator (breathing machine), which assists or does the breathing for the patient (the patient will usually be sedated so that he or she is not aware of the procedure).
• Blood-thinning medication may be given, especially in patients with severe symptoms. This is given through an IV, injected into the skin directly, or taken by mouth.
• Heparin is usually the first medication given. This is given in an IV and works to stop further clot formation from occurring. It is administered continuously through the IV.
• Another similar medication is called enoxaparin (Lovenox), or a low molecular weight heparin. This medication is given subcutaneously, or just under the skin. It only has to be given every 12 hours, but it does require an injection each time. The current trend is to use low molecular weight heparin for the treatment of pulmonary embolism. Similarly, the pentasaccharide, fondaparineux (Arixtra) may also be used.
• The oral blood-thinning medication called warfarin (Coumadin) is usually given shortly after the heparin or a low molecular weight heparin is started. The medications are continued until blood tests show that the warfarin is adequately thinning the blood. In very stable patients, much of the drug management can be done in the outpatient setting.
• "Clot buster" medications (also called thrombolytics) are given to those who are critically ill. The purpose is to break up the clot that is blocking the blood vessel in the lung. These medications are used only in those with massive pulmonary embolism, blood pressure collapse, or severely low oxygen that does not respond to treatment. Examples of these medications are reteplase (Retavase), TPA, streptokinase, and urokinase.
• In some life-threatening cases, the patient is taken to a radiologic surgery by an interventional radiologist and a catheter is placed into the pulmonary artery similar to the angiogram described above. This special catheter can break up and suck the clot out relieving the obstruction immediately.