From the Guidelines
As a paramedic treating a suspected pulmonary embolism, your primary intervention should include oxygen administration, IV access, and supportive care while rapidly transporting to a hospital. When it comes to specific administration for a pulmonary embolus, the options are limited in the prehospital setting, and the focus should be on stabilizing the patient and expediting transport to a facility capable of providing definitive care, such as thrombolysis or catheter-based interventions 1.
The management of pulmonary embolism, as outlined in the guidelines, emphasizes the importance of rapid reduction of pulmonary artery pressure, right ventricular strain, and pulmonary vascular resistance, as well as increasing systemic perfusion and facilitating right ventricular recovery 1. However, these interventions, including catheter-based therapies like aspiration thrombectomy, thrombus fragmentation, and rheolytic thrombectomy, are typically beyond the scope of prehospital care and require specialized equipment and trained personnel.
In the prehospital setting, the administration of supplemental oxygen to maintain SpO2 above 94%, establishment of IV access for potential fluid resuscitation, and consideration of pain and anxiety management with medications like morphine or fentanyl are crucial steps. For patients showing signs of severe hypotension or obstructive shock, the use of vasopressors such as norepinephrine or epinephrine may be necessary, following local protocols.
It's essential to note that while thrombolytics are a critical component of pulmonary embolism treatment, their administration in the prehospital setting is not standard and would typically require specific medical direction and protocols. The primary goal of prehospital care for suspected pulmonary embolism remains the stabilization of the patient and rapid transport to a hospital where definitive diagnostic and therapeutic interventions can be initiated.
From the FDA Drug Label
1 INDICATIONS AND USAGE
- 3 Treatment of Acute Pulmonary Embolism Fondaparinux sodium injection is indicated for the treatment of acute pulmonary embolism when administered in conjunction with warfarin sodium when initial therapy is administered in the hospital.
As a paramedic, fondaparinux sodium can be administered for the treatment of acute pulmonary embolism, but it should be given in conjunction with warfarin sodium and initial therapy should be administered in the hospital 2.
- Key points:
- Fondaparinux sodium is used for the treatment of acute pulmonary embolism.
- It should be administered with warfarin sodium.
- Initial therapy should be given in the hospital.
From the Research
Treatment Options for Pulmonary Embolus
As a paramedic, the following treatment options can be considered for a patient with a pulmonary embolus:
- Thrombolytic agents, such as alteplase or reteplase, to dissolve or reduce the clot and normalize hemodynamics 3, 4, 5
- Anticoagulant agents, such as unfractionated heparin or low molecular weight heparins, to prevent further clot formation and reduce the risk of recurrent pulmonary embolism 6, 7
- Combination therapy with heparin and thrombolytic agents, such as alteplase, for patients with submassive pulmonary embolism 5
Administration Guidelines
The administration guidelines for these treatment options are as follows:
- Alteplase: 100 mg infusion over a 2-hour period, including an initial 10-mg bolus 3, 5
- Reteplase: double bolus of 10 U, 30 minutes apart 3
- Unfractionated heparin: intravenous bolus dose of 5000 U, followed by an infusion of 1250 U/h, adjusted to maintain the aPTT at 2-2.5 times the pre-treatment value 7
- Low molecular weight heparins: dosing regimens vary depending on the specific agent and patient population 6, 7
Important Considerations
When administering these treatment options, it is essential to consider the following: