Bayram Başak, Oray Neşe Çolak, Korkmaz Emel, Erdost Hale Aksu, Gokmen Necati
Dokuz Eylul University, School of Medicine, Department of Emergency Medicine, Balcova, 35340 Izmir, Turkey.
Dokuz Eylul University, School of Medicine, Departments of Anesthesiology and Reanimation, Balcova, 35340 Izmir, Turkey.
Am J Emerg Med. 2014 Nov;32(11):1441.e1-3. doi: 10.1016/j.ajem.2014.04.022. Epub 2014 May 20.
Treatment options for pulmonary embolism are increasing, but the scale of the treatments and their availability in the emergency department (ED) are limited. Thrombolytic therapy remains the most commonly used treatment in patients who present a massive pulmonary embolism in the ED. However, systemic thrombolysis is contraindicated in certain cases, such as a known intracranial tumor or a history of cranial surgery.In this case report, we report a 63-year-old man with a history of intracranial surgery due to glioblastoma multiforme 20 days prior to being admitted to the ED. Multidetector-row computed tomography angiography revealed embolisms in both main pulmonary arteries.There was a progression of cardiac arrest while preparing for catheterization; thus, cardiopulmonary resuscitation was initiated.After administering 10 minutes of cardiopulmonary resuscitation, a50-mg alteplase bolus was given. Within minutes, a pulse has returned. No complications associated with the thrombolytic therapy were observed.Our aim was to discuss the management of massive pulmonary embolism with a contraindication to systemic thrombolytic therapy.
肺栓塞的治疗选择在不断增加，但这些治疗的规模及其在急诊科（ED）的可及性有限。溶栓治疗仍然是在急诊科出现大面积肺栓塞的患者中最常用的治疗方法。然而，全身溶栓在某些情况下是禁忌的，例如已知的颅内肿瘤或有颅脑手术史。在本病例报告中，我们报告了一名63岁男性，在入住急诊科前20天因多形性胶质母细胞瘤有颅脑手术史。多排螺旋计算机断层扫描血管造影显示双侧主肺动脉栓塞。在准备导管插入术时出现心脏骤停进展；因此，开始进行心肺复苏。在进行10分钟心肺复苏后，给予50毫克阿替普酶推注。几分钟内，脉搏恢复。未观察到与溶栓治疗相关的并发症。我们的目的是讨论对全身溶栓治疗有禁忌证的大面积肺栓塞的管理。
