Shock Syndromes II

Which would best categorize R.M.’s PE?

After initiating therapeutic heparin and monitoring,

R.M.’s blood pressure is now maintained at 90/50

mm Hg, but his oxygenation continues to worsen,

now requiring 80% Fio2. The medical team has

decided that the patient’s potential benefit from

thrombolytic therapy outweighs the potential risks.

Which is the best approach for this patient’s throm-

bolytic administration?

catheter.

As you prepare to implement the previously chosen

treatment strategy, R.M. experiences cardiac arrest

with PEA. Which is the most appropriate interven-

tion for managing R.M.’s PE in the ICU setting?

K.A. is a 50-year-old man admitted to the neuro-

critical care unit because of a head trauma causing a

subarachnoid hemorrhage. On ICU day 3, his blood

pressure is 70/50 mm Hg, and he is mechanically

ventilated. K.A. was resuscitated with a normal

saline bolus, and norepinephrine was initiated. A

TTE reveals RV dilation and tricuspid regurgitation,

and a CT scan reveals a filling defect within the pul-

monary arteries, dilatation of the right ventricle of

the heart, and enlargement of the pulmonary artery.

K.A.’s condition continues to worsen, and vaso-

pressin is added for refractory shock. Which is the

best approach for treatment of K.A.’s shock?

hours.

hours.

for

possible

catheter-directed

thrombolysis.