Intraosseous administration of thrombolysis in out-of-hospital massive pulmonary thromboembolism
- 3 June 2010
- journal article
- case report
- Published by BMJ in Emergency Medicine Journal
- Vol. 27 (8), 641-644
- https://doi.org/10.1136/emj.2009.086223
Abstract
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.Keywords
This publication has 28 references indexed in Scilit:
- Assessment of pretest probability of pulmonary embolism in the emergency department by physicians in training using the Wells modelThrombosis Research, 2007
- Derivation and Validation of a Prognostic Model for Pulmonary EmbolismAmerican Journal of Respiratory and Critical Care Medicine, 2005
- Does This Patient Have Pulmonary Embolism?Jama-Journal Of The American Medical Association, 2003
- British Thoracic Society guidelines for the management of suspected acute pulmonary embolismThorax, 2003
- Question and Answer Session After Scientific ReviewCritical Care Medicine, 2001
- Guidelines on diagnosis and management of acute pulmonary embolismPublished by Oxford University Press (OUP) ,2000
- Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)The Lancet, 1999
- Use of a Clinical Model for Safe Management of Patients with Suspected Pulmonary EmbolismAnnals of Internal Medicine, 1998
- Management Strategies and Determinants of Outcome in Acute Major Pulmonary Embolism: Results of a Multicenter RegistryJournal of the American College of Cardiology, 1997
- Right ventricular dysfunction after acute pulmonary embolism: Pathophysiologic factors, detection, and therapeutic implicationsAmerican Heart Journal, 1995