Standard dose: Alteplase 100mg over 2 hours 
Alternative dose: Alteplase 50mg over 2 hours
Half-dose regimen can be considered in patients >65yo, higher bleeding risk, or submassive PE (see  MOPETT trial)
Systemic therapy is recommended over catheter-directed therapy
Cardiac arrest dose:
Tenecteplase (not FDA approved for PE) - 50 mg bolus or 0.5 mg/kg bolus has been used for PEA arrest
Half-dose regimen can be considered in patients >65yo, higher bleeding risk, or submassive PE (see  MOPETT trial)
Tenecteplase (not FDA approved for PE) - 50 mg bolus or 0.5 mg/kg bolus has been used for PEA arrest
OR
Alteplase - 50 mg of  by IV Push over ~60 seconds
Continue CPR for 30-60 minutes after lytic administration.
Alteplase - 50 mg of  by IV Push over ~60 seconds
Continue CPR for 30-60 minutes after lytic administration.
Review  contraindications
Several trials continued unfractionated heparin (UFH) to target aPTT 1.5-2.5x baseline during<unk> administration so this would be standard 
However, discontinuing anticoagulation can be considered while administering<unk> 
Always obtain serial aPTT every 4 hours after completion of<unk> If heparin was discontinued during thrombolysis, resume heparin without a loading dose when aPTT <2x upper limit of normal
Ongoing CPR from 2010 AHA Guidelines is not an absolute contraindication, and some studies suggest permitting 15 min of CPR to allow thrombolysis to work
However, discontinuing anticoagulation can be considered while administering<unk> 
If heparin was discontinued during thrombolysis, resume heparin without a loading dose when aPTT <2x upper limit of normal
Thrombolytics for pulmonary embolism
Thrombolytics for STEMI
Thrombolytics for acute ischemic stroke
Balloon tamponade for massive GI bleeding
Resuscitative endovascular balloon occlusion of the aorta
Anti-platelet agent reversal
Cardiovascular antibiotics
Formal echocardiography