Critical actions:

recognize need for electrical cardioversion
recognize the potential need to infuse tPA if BP does not improve after cardioversion
- should have pharmacist prepare the tPA and have it ready to go if need be
discuss sedation regimens for cardioversion (see below, reference: mostly uptodate)
- methohexital IV:
  - dose: 0.75-1.5mg/kg (according to retrospective review of sedation in ED, avg dose 1.4mg/kg)
  - onset: immediate
  - duration: 5-15 mins
- etomidate IV:
  - dose: 0.15-0.3 mg/kg
  - onset: 30-60s
  - duration: 2-15 mins
  - metabolism: 76% protein bound, primarily hepatic metabolism
- ketamine IV:
  - dose: 1-2 mg/kg
  - onset: 30-60s
  - duration: anesthetic effect 5-10mins, full recovery 1-2 hours
- midazolam IV:
  - dose: 0.5mg-2mg initial dose then additional doses q2-3min. Usual required dose 2.5-5mg
  - onset: 3-5 min
  - duration: 1-2 hours (dose dependent)
Discuss PESI score and the anticoagulation regimens - heparin drip vs enoxaparin vs tPA
Discuss accuracy of POC US for PE

	Created by Zander Prewitt about 5 years ago

Pulmonary Embolism Case