RT Journal Article SR Electronic T1 Intraosseous administration of thrombolysis in out-of-hospital massive pulmonary thromboembolism JF Emergency Medicine Journal JO Emerg Med J FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine SP 641 OP 644 DO 10.1136/emj.2009.086223 VO 27 IS 8 A1 Mario Valdés A1 Pilar Araujo A1 Carmen de Andrés A1 Eva Sastre A1 Terence Martin YR 2010 UL http://emj.bmj.com/content/27/8/641.abstract AB Pulmonary thromboembolism has an incidence of more than 69/100 000 population but may be underdiagnosed because of the non-specific character of its symptoms and difficult differential diagnosis. The prognosis is worse if the pulmonary thromboembolism is massive and associated with haemodynamic instability, whereupon mortality rises to over 50%. Cardiogenic shock supervenes and cardiopulmonary arrest is often inevitable. This emergency can only be prevented by aggressive therapy with thrombolytic agents. The case history is described of a 25-year-old woman in cardiogenic shock leading to prehospital cardiac arrest in which intravenous access was impossible. Resuscitation drugs were given by the intraosseous route and, with a suspected diagnosis of massive pulmonary thromboembolism, it was decided to start thrombolysis by the same route before transport to hospital. The treatment was a complete success, and the patient was discharged from hospital with no sequelae after 39 days.