RT Book, Section A1 Pugliese, Steven C. A1 Shankar, Hari M. A2 Schmidt, Gregory A. A2 Kress, John P. A2 Douglas, Ivor S. SR Print(0) ID 1201801846 T1 Pulmonary Embolic Disorders: Thrombus, Air, and Fat T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition YR 2023 FD 2023 PB McGraw Hill PP New York, NY SN 9781264264353 LK accesssurgery.mhmedical.com/content.aspx?aid=1201801846 RD 2024/10/10 AB KEY POINTSPulmonary embolism (PE) is common and potentially lethal, yet readily treatable.Prophylaxis and accurate diagnosis are essential to improving outcome.There is no perfect diagnostic test for PE; accurate diagnosis requires both an informed clinical pretest probability and a stepwise application of helical CT angiography and/or lower extremity duplex ultrasonography.A careful risk assessment may identify patients ideal for outpatient therapy. Conversely, patients with hypotension or right ventricular (RV) strain are at significantly higher risk for death from PE, and warrant ICU admission.While low-molecular-weight heparin (LMWH) is approved and recommended as the initial therapy for PE, critically ill patients often have reason for shorter acting unfractionated heparin.Thrombolytic therapy is lifesaving in patients with high-risk PE and circulatory instability. The benefits are less clear in patients with RV dysfunction without shock as there is less hemodynamic decompensation but increased risk of bleeding.Catheter-based therapies may have a role in unstable patients with high bleeding risk and contraindications to systemic thrombolytic therapy; however, evidence is currently insufficient to recommend in patients with RV dysfunction without shock.Air and fat embolism usually present as acute respiratory distress syndrome (ARDS), and are managed with mechanical ventilation, oxygen, and positive end-expiratory pressure (PEEP).