Near-fatal pulmonary embolism.

A case of a 79-year-old female admitted to the hospital with a hip fracture and suffering a near-fatal embolism, is presented. The article then reviews the epidemiology of deep venous thrombosis and pulmonary embolism in the setting of hip fracture and orthopedic surgery and outlines the diagnostic approach to a critically ill patient with pulmonary embolism. The use of thrombolysis as an adjunct to usual heparin therapy is examined, as are the potential benefits versus the absolute risks of thrombolysis. Finally, practical recommendations outlining a reasonable approach to this group of patients, based on available evidence, are proposed.