It was not a fall, but fainting : A case report of pulmonary embolism

We encountered a case of pulmonary thromboembolism, in which an 84-year-old woman (body weight 62 kg, height 150 cm) fell in the ward eight days after upper arm surgery. In this event, she had fractured her ankle and hit her head, with transient loss of consciousness. She needed surgery for the ankle fracture under general anesthesia. Her anesthesia course was unstable, with heart rate varying between 95 and 140 bpm, systolic blood pressure between 70 and 110 mmHg, and oxygen saturation between 92 and 98%. Immediately after reversing anesthesia, we performed bedside ultrasound and diagnosed acute pulmonary embolism in the operating room. We assume that the event was not a simple fall, but pulmonary embolism-related fainting (syncope). This case and recent reports provide two lessons : (1) cases of syncope among postoperative patients may be reported as simple falls in the safety surveillance of hospitals, and (2) ultrasonography at the bedside plays a pivotal role in the diagnosis of pulmonary embolism in perioperative settings.