Citation

Serchan P, Shorten G, Maher M, Power SP. BMJ Case Rep. 2019; 12(9): e228783.

Affiliation

Radiology, HSE South, Cork, Ireland.

Copyright

(Copyright © 2019, BMJ Publishing Group)

DOI

10.1136/bcr-2018-228783

PMID

31540919

Abstract

Pulmonary embolism (PE) secondary to trauma is the third most common cause of death in trauma patients who have survived 24 hours following injury. We describe a case of PE diagnosed within 3 hours of a major trauma in a previously well adolescent female. The early occurrence of PE in this case is at odds with what is generally reported (3-5 days) after major trauma. General consensus is that patients who suffer major trauma move from an initial hypocoaguable state, with increased risk of bleeding, to normocoagulable or hypercoaguable state, with a subsequent increased risk of venothromboembolism. However, Sumislawski et al recently demonstrated that a marginally greater proportion of trauma patients were in fact hypercoaguable rather than hypocoaguable on arrival to hospital and that trauma-induced coagulopathy tended to resolve within 24 hours; such data cause us to re-evaluate when to commence thromboprophylaxis for major trauma patients.

© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Language: en

Keywords

anaesthesia; orthopaedic and trauma surgery; pulmonary embolism; radiology; trauma