This is one approach. Items to consider:
- start heparin empirically
- if patient in shock and echo demonstrates new RV pressure overload with no other cause of hypotension, treat by lysis or embolectomy
- in community ED where stat echo not always immediately available, consider sending hypotensive patient for imaging (CT, V/Q, angiogram) and if positive for PE, treat by lysis or embolectomy
- if patient looses pulses prior to completion of further testing, initiate ACLS algorithms and consider empiric lysis although there is insufficient data to argue for or against thrombolytic therapy in patients undergoing CPR due to PE-induced cardiac arrest.
Source
Wood, Kenneth. "Major Pulmonary Embolism review of a Pathophysiologic Approach to the Golden Hour fo Hemodynamically Significant Pulmonary Embolism." Chest. V 121 Issue 3. March 2002.
Tapson, V. "Fibrinolytic therapy in pulmonary embolism and deep vein thrombosis." Up to Date. 3 June 2008.
