Fulminant Pulmonary Embolism Successfully Treated with Thrombolysis

 Fulminant Pulmonary Embolism Successfully Treated with Thrombolysis

A 70 year-old man, with a history of major depression and arterial hypertension, was admitted to the emergency department for severe hypotension and suspected abuse of anti anxiety drugs. Due to the rapid deterioration of his clinical conditions a bed-side echocardiography was rapidly performed,that was compatible with acute pulmonary embolism. During echocardiography, the patient developed a pulseless electrical activity with residual cardiac contractility (pseudo PEA) that evolved into pulseless electrical activity without cardiac contractility (true PEA). After 20 minutes of cardiopulmonary resuscitation (CPR), empirical alteplase 50 mg + 50 mg was administered intravenously over 5 minutes, with restoration of spontaneous circulation. PE was confirmed by computed tomographic angiography. His hospital stay was complicated by non-hemorrhagic neurological impairment that resulted in quadriplegia.