A 72-year-old female with history of OSA, recent tibula & fibular fracture s/p ORIF presents to the hospital with shortness of breath and was found to have bilateral submassive pulmonary embolisms and underwent EKOS thrombolysis and was discharged with Eliquis.

She returns to the hospital within 24 hours after a slip from bed with a left ankle dislocation. In the OR she had a cardiac arrest with return of spontaneous circulation. In the ICU, she was given systemic alteplase for worsening right heart strain and started on a heparin drip. As a result, obstructive shock greatly improved. Transthoracic echocardiogram demonstrated mod-severe global right ventricular hypokinesis and flattened septum with EF of 40%. She was eventually extubated and was discharged home.