EARLY PULMONARY EMBOLISM IN THE SETTING OF POLYTRAUMA REQUIRING CATHETER DIRECTED EMBOLECTOMY AND THROMBOLYSIS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Early respiratory failure in the trauma population is often acute distress syndrome, pulmonary contusion, and transfusion-related lung injury, while embolism (PE) usually a late cause. The following case report reflects scenario where critically ill patient developed PE within hours of presentation features tiered approach to its management. CASE PRESENTATION: A 42-year-old previously healthy man presented hospital after motor vehicle collision. He was extremis. His apparent injuries were bilateral traumatic lower extremity amputations. Massive transfusion protocol initiated for hemorrhagic shock, he intubated arterial blood gas with pH 6.9 base deficit -22. went operating room his injuries, post-operatively had imaging performed. CTA chest revealed right upper artery filling defects, concerning PE. In setting systemic anticoagulation not pursued at that time. Thus, an inferior vena cava filter placed on first day hospitalization. Over next few days, extubated weaned from supplemental oxygen. repeat performed episode desaturation, which showed propagation sided five days so started. While therapeutic heparin drip, hypoxemic requiring re-intubation. Despite mechanical ventilation PEEP 10 FiO2 100%, continued decline. Interventional radiology consulted emergently, angiogram confirmed main embolism. Catheter directed thrombolysis embolectomy After procedure, far improved. Ultimately, off oxygen entirely before discharge. DISCUSSION: This unique demonstration provoked early patient's clinical course. Within event, findings treated according treatment algorithm. Inferior initially utilized due contraindications anticoagulation/thrombolysis. Anticoagulation when appropriate, especially signs progression clinically imaging. Finally, despite appropriate maximal medical therapy. More invasive measures implemented including emergent catheter thrombolysis. CONCLUSIONS: interesting developing injury. management, it lead failure. ultimately responded well thrombectomy make full recovery. REFERENCE #1: Salim et al. Acute Respiratory Distress Syndrome Trauma Intensive Unit: Morbid but Not Mortal. Arch Surg. 2006;141(7):655-658. #2: Rivera-Lebron Diagnosis, Treatment Follow Up Pulmonary Embolism: Consensus Practice PERT Consortium. Clin Appl Thromb Hemost. 2019 Jan-Dec; 25: 1076029619853037. PMID: 31185730 DISCLOSURES: No relevant relationships by Ernest Block, source=Web Response Sanjiv Gray, Michael Shockley,