A 28-year-old woman, status post-C-Section one month back, presented to the ED with severe shortness of breath that had begun a day earlier. Fifteen days before, she had experienced a left leg swelling that mysteriously disappeared on its own.

Upon arrival, her vitals painted a concerning picture: she had borderline low blood pressure, tachycardia, and tachypnea, yet her oxygen levels were miraculously stable. Her ECG told a more dramatic story, revealing an S1Q3T3 pattern, sinus tachycardia, T-wave inversions in V1 and Lead III, and signs of right ventricular strain.

The chest X-ray added to the tension, showing peri-hilar congestion. The definitive blow came from the CTPA, confirming a hefty thrombus in the right main pulmonary artery and another in the left segmental artery.

Diagnosed with hemodynamically unstable sub-massive pulmonary embolism (PE), pulmonology initially recommended IV anticoagulation. However, the emergency team, recognizing the gravity of the situation, pushed for more aggressive treatment with tPA.

This case highlights a crucial aspect of emergency medicine: the ability to influence and even challenge other specialties to revisit their decisions. It's not just about consulting specialists to dictate care but leveraging their expert opinions to make the best possible decision for the patient in a critical moment.

The decision proved lifesaving. After the administration of tPA, the patient's condition improved dramatically, underscoring the high-stakes, rapid-response nature of emergency medicine. This case is a vivid reminder of how critical and immediate interventions can turn the tide in life-threatening scenarios.

P.S: The focused cardiac PoCUS was done bedside in the ER.