ArticleFrontiers in cardiovascular medicine2026
Successful management of life-threatening acute pulmonary embolism during anesthesia induction for comminuted intertrochanteric fracture surgery: a case report.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acute perioperative pulmonary embolism (APE) is a life-threatening complication that demands immediate clinical recognition and intervention. This report describes the emergency management and successful recovery of an 85-year-old female who experienced sudden, catastrophic cardiovascular collapse due to APE immediately following general anesthesia induction for orthopedic surgery. Methods: A retrospective analysis was conducted on an 85-year-old female admitted with an un-stabilized comminuted intertrochanteric fracture of the right femur. The study chronologically details the clinical presentation during an 11-day preoperative immobilization window, the intraoperative crisis management utilizing real-time bedside diagnostics, and the subsequent multidisciplinary rescue protocol involving targeted pharmacological thrombolysis and intensive care stabilization. Results: Initial screening revealed a profound hypercoagulable state. Following anesthesia induction, the patient experienced sudden cardiovascular collapse and new-onset atrial fibrillation with complete right bundle branch block. Bedside echocardiography rapidly confirmed right ventricular enlargement, indicating massive APE and obstructive shock. An emergency low-dose systemic thrombolysis regimen (50 mg alteplase) was successfully executed. Post-thrombolysis evaluations in the intensive care unit noted expected consumptive coagulopathy and transient anemia, managed via supportive care and blood transfusion. Computed tomography pulmonary angiography confirmed bi-lobed pulmonary embolism. Under multidisciplinary optimization and transitioned rivaroxaban therapy, the patient achieved complete clinical recovery at 1-year follow-up. Conclusions: This case underscores the importance of intraoperative point-of-care ultrasound and electrocardiographic monitoring in fragile geriatric patients undergoing extended preoperative delays. When mechanical options are unavailable, low-dose systemic thrombolysis can serve as a viable rescue pathway to reverse acute obstructive shock, though its wider generalizability requires cautious interpretation.
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