153: Remix: Managing Crashing Pulmonary Embolism Patients
About this episode
This episode revisits the management of pulmonary embolism patients, highlighting the rapid deterioration that can occur and discussing treatment options.
Pulmonary embolisms don’t always announce themselves... sometimes they ambush. One minute your patient is walking with physical therapy, the next they’re hypotensive, hypoxic, and coding. This re-released early episode dives deep into why PE patients can look deceptively stable… right up until they aren’t. In this episode, I revisit one of my earliest case-based teachings on pulmonary embolism, updated with an added segment on vasopressin use in obstructive shock from PE. Through real bedside stories from my time as a rapid response and ER nurse, we break down the physiology behind PE-related collapse, why intubation isn’t always the answer, and how to think through management when the right ventricle is failing in front of you. This is a sobering but essential refresher on one of the most dangerous diagnoses we encounter. Topics discussed in this episode: Why pulmonary embolism is a common cause of in-hospital cardiac arrest (even if it’s not common overall) Classic and subtle PE presentations and why they’re often missed A real-time rapid response case: stable to crashing in minutes Risk factors for PE and the anticoagulation double-edged sword Obstructive shock explained…
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