ABSTRACT
This chapter presents a case study of a 60-year-old man who is brought in to the Emergency Department after collapsing at work. He has a history of multiple myeloma and is on oral maintenance chemotherapy. The patient presents with shortness of breath and a syncopal episode. The key diagnoses to consider are cardiopulmonary, including acute coronary syndromes (ACS), pulmonary embolism (PE), cardiac disease, as well as more benign conditions such as a vasovagal episode. The initial approach to managing this patient should proceed along the 'ABCDE' approach. Baseline blood tests including a full blood count, electrolytes, clotting screen and group and save should be performed. The definitive investigation to diagnose PE is CT pulmonary angiography (CTPA), but in this case, there is evidence of haemodynamic instability and circulatory collapse. In patients with suspected massive PE who are haemodynamically unstable or shocked, thrombolytic therapy with intravenous alteplase 10 mg followed by an infusion of 90 mg over 2 hours is indicated.
