Volume 68 Number 6 November 2001	back to contents

Grand Rounds Near-Fatal Pulmonary Embolism	370-377
Louis R. DePalo, M.D.
Address correspondence to Louis R. DePalo, M.D., F.C.C.P., Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Box 1232, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029. Adapted from a Grand Rounds presentation to the Department of Medicine, Mount Sinai School of Medicine, New York, NY on December 24, 1996.

ABSTRACT
A case of a 79-year-old female admitted to the hospital with a hip fracture and suffering a near-fatal embolism, is presented. The article then reviews the epidemiology of deep venous thrombosis and pulmonary embolism in the setting of hip fracture and orthopedic surgery and outlines the diagnostic approach to a critically ill patient with pulmonary embolism. The use of thrombolysis as an adjunct to usual heparin therapy is examined, as are the potential benefits versus the absolute risks of thrombolysis. Finally, practical recommendations outlining a reasonable approach to this group of patients, based on available evidence, are proposed.

KEY WORDS
Pulmonary embolism, thrombolytic therapy, echocardiography.

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