title: Bomb Blast and Its Consequences: Successful Intensive Care Management of Massive Pulmonary Embolsim.
abstract: A suicide bomb blast in 2013 at a distant city of Pakistan killed 84 and wounded more than 150 people. Some patients were transferred to our tertiary care hospital because of extreme load on medical services there. This patient arrived at the Aga Khan Hospital, 2 days after the bomb blast injury and underwent an orthopedic procedure. Next day, he developed sudden tachypnea, desaturation, and circulatory collapse. After initial cardiopulmonary resuscitation, he was immediately transferred to surgical intensive care unit. Based on history, echocardiography findings and patient parameters, a clinical diagnosis of massive pulmonary embolism was made and immediate thrombolytic therapy with alteplase was started. The immediate improvement in hemodynamic status was evident following 2 hours of alteplase infusion. This case also highlights the aggressiveness of resuscitation, decision making in initiating thrombolytic therapy on clinical grounds, importance of deep venous thrombosis prophylaxis, and exhaustion of health resources due to blast related mass destruction.
authors.affiliation: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi.
authors.forename: Faisal
authors.initials: F
authors.lastname: Shamim
authors.affiliation: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rizwan
authors.affiliation: Department of Medicine, The Aga Khan University Hospital, Karachi.
authors.forename: Adil
authors.initials: A
authors.lastname: Aziz
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D054042:Bombs; D003422:Critical Care; D004452:Echocardiography; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator