The use of transthoracic echocardiography to guide thrombolytic therapy during cardiac arrest due to massive pulmonary embolism.

CASE REPORT A 25 year old woman presented to our accident and emergency department with a three hour history of retrosternal pleuritic chest pain and dyspnoea. She was previously completely well, was a non-smoker and her only medication was a levonorgestrel-based second generation oral contraceptive. Initial clinical examination revealed moderate obesity, tachypnoea (oxygen saturation of 94% on air) and a tachycardia of 110 bpm. There were no other abnormal clinical signs and no evidence of lower limb venous thrombosis. 12-lead ECG showed an “S1Q3T3” pattern. After initial assessment she was accompanied to the toilet, where she collapsed with no palpable cardiac output. She was immediately transferred to the resuscitation room. Appropriate cardiopulmonary resuscitation was started and electromechanical dissociation was noted. A presumptive diagnosis of massive pulmonary embolism was made. She was give 3×1 mg