Critically evaluate the role of thrombolysis in pulmonary embolism.
In the following groups:
Catheter directed thrombolysis:
This is an area of enormous practical significance AND a common problem. Candidates were not expected to know the details of individual studies, but to be able to show a reasonable understanding of the state of play of the evidence.
A satisfactory answer was expected to include the following:
- Rationale for using thrombolysis with risks and benefits
- Discussion of use in sub-massive PE and cardiac arrest
- Reference to evidence
In general, candidates who failed gave either clearly inaccurate statements or superficial answers.
The following topic headings were structured according to the examiner's impression of what a "satisfactory answer" might contain.
Evidence in support of thrombolysis for massive PE:
Evidence for and against thrombolysis in sub-massive PE:
Oh's Intensive Care manual: Chapter 34 (pp. 392) Pulmonary embolism by Andrew R Davies and David V Pilcher
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