Lungs Full of Clot, Lytics Forbidden - Vascular Medicine clinical simulation case. A 58-year-old male, post-operative day 3 from an elective right...
Age: 58 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
A 58-year-old male, post-operative day 3 from an elective right parietal craniotomy for meningioma resection, now acutely decompensating on the neurosurgical ward with sudden dyspnea, tachycardia, hypoxemia, and hypotension consistent with intermediate-high risk pulmonary embolism. Systemic thrombolysis is categorically contraindicated given recent intracranial surgery.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Catheter-directed MECHANICAL thrombectomy (FlowTriever, Indigo) avoids fibrinolytic exposure entirely — the safest reperfusion option in post-surgical patients.
PERT activation is standard of care for intermediate-high/high-risk PE and coordinates multidisciplinary decision-making (interventional radiology, cardiac surgery, critical care, neurology/neurosurgery).
Aggressive IV fluids are HARMFUL in acute RV failure with cor pulmonale — the RV is already volume-overloaded; pressors and judicious diuresis/milrinone are preferred.
Post-procedural management requires monitoring for delayed intracranial bleeding, residual DVT, and anticoagulation titration before safe discharge.
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