The content written is solely fiction. Medical scenarios are for storytelling and character development, not professional advice; inaccuracies may occur. Some topics may explore critical conditions—trigger warnings will be provided if needed. Reader discretion is advised.
Trigger Warning: Medical Trauma, Cardiac Emergency, Possible Violence, and Attempted Homicide
Previously:
Shiv, arriving at the scene after just a brief sleep, watched as the trauma team worked swiftly around the patient. His injuries didn’t match a long fall—bruises across his chest, swollen eyelids, and an open wound on his femur.
“ECG is showing nonspecific ST-T changes,” Soleil, her most trusted resident, reported. “Troponins are slightly elevated.”
She frowned at the strangeness. “His heart’s under stress, but not from blunt trauma. Something else happened before he hit the ground.”
A nurse called out, “BP’s dropping—98 over 60. Tachycardic at 122.” She speculated that if his injuries weren’t consistent with trauma, then something else had led to his collapse. “Dr. Soleil, we need an aortogram and pulmonary angiography—stat.”
“Pulmonary embolism?” Soleil asked, already signaling for the scan.
“It fits,” Shiv stated. “A sudden PE could have caused syncope. If he collapsed near a window, he might not have fallen—he might have been pushed after losing consciousness.”
They rushed him to imaging, the machines whirring as contrast dye illuminated the hidden battle inside his body. There it was. A pulmonary embolism. A massive clot blocking circulation in his lungs.
Soleil swore under her breath. “That explains the collapse.”
Calmly interpreting the result, Shiv added. “It also means he never jumped. He lost consciousness before he ever hit the ground.”
Back in the trauma bay, the patient’s vitals were deteriorating. His heart was struggling, starved of oxygen, his breathing rapid but shallow. He was in danger of cardiac arrest. Fast, Shiv instructed her team. “We need immediate anticoagulation. Get a heparin drip started—low dose. We have to break down the clot before it causes a full-blown infarction.”
Soleil grabbed the medication, carefully calculating the dosage. Heparin, an anticoagulant, would help dissolve the clot, but it came with a risk—his open leg wound. If they thinned his blood too much, he could bleed out.
“We’ll titrate the dose carefully,” Soleil said, adjusting the IV pump as the anticoagulant began flowing into his bloodstream.
“Good call. Keep an eye on his BP. If it drops further, we’ll need vasopressors to support perfusion.” The team moved swiftly following her instructions. Meanwhile, a nurse secured a compression bandage over his femoral wound, monitoring for any signs of excessive bleeding.
His oxygen levels were still a concern. “Dr. Shiv, he’s desaturating,” Soleil warned. “SpO2 dropping to 91% despite high-flow oxygen.”
Responding in seconds, she called a respiratory therapist. “Increase O2 flow. If he worsens, we prepare for intubation.” His body was struggling against the clot, but they needed to do more than just slow it down. “Get alteplase ready.” They begin again. “If he doesn’t improve in the next thirty minutes, we start thrombolysis.”
Soleil hesitated. “That could worsen his bleeding.”
“And if we don’t act, his heart won’t survive,” She countered.
The minutes stretched long, filled only by the rhythmic beeping of the monitors. Then—his heart rate began to stabilize. His oxygen levels steadied.
Soleil let out a breath. “He’s responding.”
Shiv allowed herself a small relief, but she stayed cautious. The man was still unconscious, but alive. His heart had fought through a deadly clot, through trauma, and through something else—something that had happened before he ever left that building.
