LAUSR

Study/Objective: To report on the first successful management of a patient with acute massive bilateral Pulmonary Embolism, at the Komfo Anokye Teaching Hospital Emergency Department (KATH ED), Kumasi, Ghana. Background: Pulmonary Embolism (PE) is an acute silent killer in developing countries, and is primarily a diagnosis of clinical suspicion. There are limitations in its diagnosis and interventions, increasing the mortality tendencies. Acute massive bilateral PE carries an exceptionally high mortality rate even with interventions. Methods: We sought to describe the management of the first successful thrombolysis of a patient with acute massive bilateral PE who presented to our ED at KATH, because there is paucity of literature on successful ED management of such cases in Ghana. Results: A 23 year-old woman, 2-months pregnant, G4P0 , admitted with sudden onset of breathlessness, chest pain and a history of hemoptysis one week earlier. No significant past medical history. BP was unrecordable, tachycardia, saturating <90% on oxygen, with deteriorating mental status. She was intubated and started on IVFs and subsequently, dobutamine. Bedside ultrasound revealed a dilated Right ventricle, full IVC and a gestational sac. No evidence of DVT. ECG showed sinus tachycardia, extreme left-axis-deviation, S-wave in lead I; Q-wave and T-wave inversion in lead III. Wells Score was 5.5. Normal chest X-ray and chest CT-Angiography showed acute bilateral massive PE. Thrombolysis was used with Streptokinase via central line after obtaining a clotting profile. She spontaneously aborted and the evacuation of the uterus was done. CPR was done following an episode of cardiac arrest, and Return of Spontaneous Circulation (ROSC) was achieved. She was admitted to the ICU, extubated and discharged home on warfarin on Day 12. She currently attends her review sessions and was given counsel for preconception care. Conclusion: High-risk emergencies can be managed in low resource settings. There is, however, the need for available and affordable diagnostic resources, medications and logistics to promptly identify and appropriately manage such cases.