153: Remix: Managing Crashing Pulmonary Embolism Patients

Pulmonary embolisms don’t always announce themselves... sometimes they ambush.

One minute your patient is walking with physical therapy, the next they’re hypotensive, hypoxic, and coding. This re-released early episode dives deep into why PE patients can look deceptively stable… right up until they aren’t.

In this episode, I revisit one of my earliest case-based teachings on pulmonary embolism, updated with an added segment on vasopressin use in obstructive shock from PE. Through real bedside stories from my time as a rapid response and ER nurse, we break down the physiology behind PE-related collapse, why intubation isn’t always the answer, and how to think through management when the right ventricle is failing in front of you. This is a sobering but essential refresher on one of the most dangerous diagnoses we encounter.

Topics discussed in this episode:

1. Why pulmonary embolism is a common cause of in-hospital cardiac arrest (even if it’s not common overall)
2. Classic and subtle PE presentations and why they’re often missed
3. A real-time rapid response case: stable to crashing in minutes
4. Risk factors for PE and the anticoagulation double-edged sword
5. Obstructive shock explained: what’s actually killing the patient
6. Right ventricular failure, septal bowing, and the spiral of death
7. Why intubation can worsen outcomes in massive PE
8. Vasopressors in PE: norepinephrine, epinephrine, and vasopressin
9. The unique benefits of vasopressin in obstructive shock
10. Thrombolysis vs. thrombectomy: when TPA helps — and when it’s deadly
11. Bedside echo findings that point to massive PE
12. Why PE patients can crash during transport (and what to always bring)
13. Nursing vigilance, rapid escalation, and activating help early
14. When perfect care still isn’t enough and the heart of nursing in end-of-life moments

Mentioned in this episode:

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