Balancing High Clinical Suspicion Against Doubts: A Clinical Dilemma

Öz

Pulmonary embolism (PE) is a significant cause of mortality and is often difficult to diagnose, frequently being overlooked. Current clinical guidelines recommend fibrinolytic therapy for high-risk PE patients without contraindications. However, evidence indicates that fibrinolytic therapy is administered to only approximately 33% of eligible high-risk pulmonary embolism patients. We aim to present a case of successful resuscitation in a 54-year-old female patient with a history of head trauma and suspected gastrointestinal bleeding who presented to our emergency department with dyspnea and later suffered a witnessed cardiac arrest. Fibrinolytic therapy was given during cardiopulmonary resuscitation, leading to the return of spontaneous circulation. The use of fibrinolytic therapy in high-risk pulmonary embolism patients remains a complex and often controversial decision, especially when relative contraindications are present. This case underscores the critical importance of individualized clinical judgment and timely intervention, even in the context of potential bleeding risks. It further illustrates that, with careful risk–benefit evaluation and multidisciplinary collaboration, fibrinolytic therapy can be a life-saving measure in selected patients.

Anahtar Kelimeler

• Pulmonary embolism
• Thrombolytic therapy
• Resuscitation

Etik Beyan

Conducted in accordance with the 1989 Helsinki Declaration

Yüksek Klinik Şüphe ile Şüpheleri Dengelemek: Klinik Bir İkilem

Öz

Pulmoner emboli (PE) tanısı zor ve gözden kaçabilen önemli bir mortalite sebebidir. Mevcut kılavuzlar kontraendikasyonu bulunmayan yüksek riskli pulmoner emboli hastalarında fibrinolitik tedaviyi önermektedir. Fakat yapılan çalışmalarda fibrinolitiklere uygun yüksek riskli PE’li hastaların yaklaşık %33’ünün bu tedaviyi aldığı ileri sürülmektedir. Acil servisimize nefes darlığı şikayetiyle başvuran 54 yaşındaki kafa travması öyküsü olan ve şüpheli bir gastrointestinal kanama öyküsü alınan kadın hastanın tanıklı arrest olması sonrası resüsitasyon sırasında uygulanan fibrinolitik tedaviyle başarılı resüsitasyonu sunmayı amaçlıyoruz. Yüksek riskli pulmoner embolili hastalarda fibrinolitik tedavinin uygulanması, özellikle de göreceli kontrendikasyonların varlığında, karmaşık bir karar olmaya devam etmektedir. Bu vaka, potansiyel kanama riskleri mevcut olsa bile, bireyselleştirilmiş değerlendirmenin ve zamanında müdahalenin önemini vurgulamaktadır.

Anahtar Kelimeler

• Pulmoner emboli
• Trombolitik tedavi
• Resüsitasyon

Etik Beyan

1989 Helsinki Bildirgesi’ne uygun olarak yürütülmüştür

Kaynakça

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