{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:49:34Z","timestamp":1782107374285,"version":"3.54.5"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute perioperative pulmonary embolism (APE) is a life-threatening complication that demands immediate clinical recognition and intervention. This report describes the emergency management and successful recovery of an 85-year-old female who experienced sudden, catastrophic cardiovascular collapse due to APE immediately following general anesthesia induction for orthopedic surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on an 85-year-old female admitted with an un-stabilized comminuted intertrochanteric fracture of the right femur. The study chronologically details the clinical presentation during an 11-day preoperative immobilization window, the intraoperative crisis management utilizing real-time bedside diagnostics, and the subsequent multidisciplinary rescue protocol involving targeted pharmacological thrombolysis and intensive care stabilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Initial screening revealed a profound hypercoagulable state. Following anesthesia induction, the patient experienced sudden cardiovascular collapse and new-onset atrial fibrillation with complete right bundle branch block. Bedside echocardiography rapidly confirmed right ventricular enlargement, indicating massive APE and obstructive shock. An emergency low-dose systemic thrombolysis regimen (50\u2005mg alteplase) was successfully executed. Post-thrombolysis evaluations in the intensive care unit noted expected consumptive coagulopathy and transient anemia, managed via supportive care and blood transfusion. Computed tomography pulmonary angiography confirmed bi-lobed pulmonary embolism. Under multidisciplinary optimization and transitioned rivaroxaban therapy, the patient achieved complete clinical recovery at 1-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case underscores the importance of intraoperative point-of-care ultrasound and electrocardiographic monitoring in fragile geriatric patients undergoing extended preoperative delays. When mechanical options are unavailable, low-dose systemic thrombolysis can serve as a viable rescue pathway to reverse acute obstructive shock, though its wider generalizability requires cautious interpretation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1791835","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:40:09Z","timestamp":1782106809000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful management of life-threatening acute pulmonary embolism during anesthesia induction for comminuted intertrochanteric fracture surgery: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Minghao","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The First People\u2019s Hospital of Jiashan","place":["Jiaxing, Zhejiang Province, 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