Polytrauma patient with a massive pulmonary embolism and ischemic stroke in the setting of a patent foramen ovale
Year: 2024
Type: article
Study design: Case Report
Abstract: A patient in their 50s presented as a level-2 trauma activation after a motor vehicle collision. Their primary survey was intact. A FAST examination demonstrated a trace pericardial effusion without hemodynamic compromise and absent intraperitoneal fluid. Further radiographic investigations found left fourth through eighth and right seventh and eighth rib fractures, a right femur fracture, and right first through fourth metatarsal fractures. The patient was admitted to the Trauma Service, started on deep vein thrombosis (DVT) chemoprophylaxis (Lovenox 30 mg two times per day), and underwent a right femoral intramedullary nail placement and right metatarsal open reduction and internal fixation. The patient’s hospital course was complicated by (1) acute blood loss anemia (hemoglobin: 6.6 g/dL) secondary to a splenic laceration not present on index imaging requiring splenic and left gastric artery embolization ( figure 1a,b), and (2) delayed bilateral upper extremity weakness secondary to chronic spinal stenosis and cervical subluxation found on MRI requiring a C3-6 decompressive laminectomy. In the setting of a newly found left lower extremity DVT, an inferior vena cava (IVC) filter was placed due to institutional protocol to refrain from chemoprophylaxis immediately after neurosurgical interventions. Heparin 7500U TID was started on postoperative day 4. On the planned day of discharge, the patient underwent a left upper extremity ultrasound due to new onset edema in the setting of a previously placed peripherally inserted central catheter. An extensive DVT was found in the left innominate, axillary, and brachial veins. Later that day, secondary to acute onset hypoxia (SpO2: 75%), tachycardia (HR: 135 BPM), and hypotension (SBP: 70 mm Hg), the patient was intubated and required three vasopressors to maintain a MAP of 65 mm Hg. A CT pulmonary embolus protocol angiogram showed evidence of acute bilateral pulmonary arterial emboli (figure 1c,d).
Source: Trauma Surgery & Acute Care Open
Institutions: University of Chicago, University of Chicago Medical Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,100
OpenAlex ID: W4405410053