Management of Pulmonary Embolism with Hampton Hump

Initial Assessment and Risk Stratification

The European Society of Cardiology recommends assessing clinical state immediately to determine severity of pulmonary embolism (PE): cardiac arrest, deteriorating condition, or stable condition 1, 2
The British Thoracic Society suggests checking for signs of massive PE: collapse/hypotension, unexplained hypoxia, engorged neck veins, and right ventricular gallop 1, 2
Evaluate hemodynamic stability - this is the primary determinant of management approach, as stated by the European Heart Journal 3, 2
Consider clinical prediction scores (Wells' rule or Revised Geneva score) to confirm PE probability, according to the European Heart Journal 3

For hemodynamically unstable patients, the American Heart Association recommends initiating CPR if in cardiac arrest, and administering 50 mg alteplase IV immediately 1, 2
The American College of Chest Physicians suggests reassessing after 30 minutes, and for deteriorating patients, contacting consultant immediately and administering 50 mg alteplase IV 1, 2
In stable patients with confirmed massive PE, the British Thoracic Society recommends administering 100 mg alteplase over 90 minutes 1, 2
Follow thrombolysis with unfractionated heparin after 3 hours, preferably weight-adjusted, as suggested by the American College of Cardiology 1, 2

Do not delay transfer of unstable patients for additional imaging studies, as stated by the European Heart Journal 3
In life-threatening PE, contraindications to thrombolysis should be ignored, according to the American Heart Association 1, 2
Do not rely solely on D-dimer testing in patients with high clinical probability of PE or probable massive PE, as recommended by the British Thoracic Society 2, 4