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Reflections on prehospital care
Prehospital care
Prehospital thrombolysis of a massive pulmonary embolus
  1. Z B Perkins1,
  2. C Mitchell1,
  3. O Donald2
  1. 1
    Kent Surrey Sussex HEMS, UK
  2. 2
    Staffordshire Ambulance Service NHS Trust, Stafford, UK
  1. Dr Z B Perkins, Kent Air Ambulance Trust, Wheelbarrow Park Estate, Pattenden Lane, Marden, Kent TN12 9QJ, UK; zaneperkins{at}gmail.com

https://doi.org/10.1136/emj.2008.059022

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    A 999 call was received for a 51-year-old man collapsed at home. The patient was found slumped on the floor, complaining of acute onset of shortness of breath. There was no chest pain and the medical history was only significant for a current episode of superficial lower limb thrombophlebitis.

    Examination revealed a patent airway, profound central cyanosis, tachypnoea (28/min) and marked respiratory distress. He was diaphoretic with delayed capillary refill and no palpable peripheral pulses. He was drowsy but responsive to voice. Monitoring demonstrated a tachycardia of 148 bpm with unrecordable peripheral oxygen saturation (Spo2) and non-invasive blood pressure.

    High concentration oxygen was administered and a total of 1000 ml crystalloid fluid was titrated as boluses with no clinical improvement. A 12-lead ECG showed a narrow complex tachycardia with incomplete right bundle branch block and an S1Q3T3 pattern.

    Massive pulmonary embolism (MPE) causing life-threatening circulatory collapse was suspected. The patient consented to thrombolysis and no contraindications were present. A …

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    Footnotes

    • Competing interests: None.

    • Patient consent: Informed consent was obtained for publication of the person’s details in this report.