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The use of transthoracic echocardiography to guide thrombolytic therapy during cardiac arrest due to massive pulmonary embolism
  1. P MacCarthy1,
  2. A Worrall1,
  3. G McCarthy2,
  4. J Davies1
  1. 1Department of Cardiology, Royal Gwent Hospital, Newport, Gwent, UK
  2. 2Department of Accident and Emergency Medicine, Royal Gwent Hospital
  1. Correspondence to:
 Dr J Davies, Department of Cardiology, Royal Gwent Hospital, Newport, Gwent NP20 2UB, UK;

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The use and potential benefits of the focused trauma ultrasound examination in the accident and emergency setting has been increasingly recognised in recent years.1 We report a case re-emphasising the benefits of immediate access to skilled ultrasound examination in the critically ill non-trauma patient.


A 25 year old woman presented to our accident and emergency department with a three hour history of retrosternal pleuritic chest pain and dyspnoea. She was previously completely well, was a non-smoker and her only medication was a levonorgestrel-based second generation oral contraceptive. Initial clinical examination revealed moderate obesity, tachypnoea (oxygen saturation of 94% on air) and a tachycardia of 110 bpm. There were no other abnormal clinical signs and no evidence of lower limb venous thrombosis. 12-lead ECG showed an “S1Q3T3” pattern.

After initial assessment she was accompanied to the toilet, where she collapsed with no palpable cardiac output. She was immediately transferred to the resuscitation room. Appropriate cardiopulmonary resuscitation was started and electromechanical dissociation was noted. A presumptive diagnosis of massive pulmonary embolism was made. …

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