Major pulmonary embolism.

The scope and spectrum of pulmonary embolism (PE) that are likely to challenge the intensivist are dominantly confined to 2 scenarios; first, a patient presenting with undifferentiated shock or respiratory failure and, second, an established intensive care unit (ICU) or hospital patient who develops hemodynamically unstable PE after admission. In either scenario, the diagnostic approach and therapeutic options are challenging. Differentiating PE from other life-threatening cardiopulmonary disorders can be exceedingly difficult. This article will review a structured pathophysiologic approach to the diagnostic, resuscitative and management strategies related to PE in the ICU.