Abstract Body

Background and Purpose: Pulmonary thromboembolism (PTE) results from the obstruction of the pulmonary arteries by a thrombus. The clinical presentation is extremely variable but 90% of the patients present with recent onset dyspnea, chest pain or discomfort and syncope.

Methods: The patient (female, 84 years old) was clinically interviewed. Her clinical history, available on the Portuguese national health digital platform, was surveyed.

Results: The patient has Hypertension, Type 2 Diabetes mellitus, Varicose veins, and a recent clavicle fracture. She visited our family health center for a leg ulcer treatment and had a collapse. Subjectively she denied any symptoms, stating “I’m fine, I just want to have the dressing changed and get going”. The objective examination showed a regular pulse, BP 109/63 mmHg, apparently normal pulmonary auscultation (difficult to perform due to the presence of a shoulder spica) and O2 Sat.: 86-90%. After effective communication, she agreed to go to the ER: diagnostic investigations showed mild anaemia, d-dimers 25892 ng/mL, pro-BNP 342 mg/dL, Troponins 140 pg/mL and C-reactive protein 11.98 mg/dL. Computed tomography angiography showed extensive pulmonary thromboembolism of the main pulmonary arteries.

Conclusions: During the state of emergency caused by the COVID 19 Pandemic, Family Physicians were forced to ponder with the maximum care ER referrals, facing opposition from patients and other healthcare providers. Upon clinical suspicion of PTE, an emergency referral is warranted, given that the untreated mortality of the disease is 30%.