Correct!
2. Fibronolysis with systemic tPA administered through a peripheral intravenous catheter.

The Antithrombotic Therapy and Prevention of Thrombosis Evidence Based Practice Guidelines published by the American College of Chest Physicians recommend systemic over local tPA therapy and short infusion times, (two hours) over prolonged infusion time (>12 hours) (2). The use of tPA through a pulmonary-artery catheter has resulted in more bleeding at the catheter insertion site without an accelerated clot lysis. The shorter tPA infusion times have been associated with more rapid clot lysis than the longer infusion times, and longer infusion times increase the risk for bleeding.

As you are waiting for a formal CT pulmonary angiography with contrast and given the patient’s clinical presentation with acute refractory hypoxemia leading to cardiopulmonary arrest, which of the following is the next step? (Click on the correct answer to proceed to the next panel)

1. Considering his successful cardiac arrest resuscitation, initiate hypothermia protocol.
2. Initiate anticoagulation while performing review of any possible contraindications to tPA therapy.
3. Request stat interventional cardiology consultation for possible PCI.
4. Stat cardiothoracic surgery consultation for possible embolectomy.

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