Pulmonary Embolism Negligence

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You may be eligible for medical negligence compensation if you have suffered a Pulmonary Embolism or DVT which was misdiagnosed or treated incorrectly.

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Deep vein thrombosis and pulmonary embolism are related conditions in that deep vein thrombosis can go to become a pulmonary embolism about fifteen percent of the time.  Deep vein thrombosis involves getting a blood clot that usually begins in the lower part of the veins of the legs and the clot travels up the leg, getting as high as the thigh, pelvis and abdomen.  The higher the blood clot in the legs, the greater is the risk of the clot going to become a pulmonary embolism. 

A pulmonary embolism is when the clot in a deep vein thrombosis travels to the lungs.  If the clots are small, they settle in the small arteries of the lungs, leading to shortness of breath from lack of oxygen, pleuritic chest pain (which is chest pain that is worse on inspiration), and sometimes low oxygen level and anxiety symptoms.  A big clot can often land at the entrance of both arteries that enter the lungs.  This is a severe condition that often leads to sudden death.  It is estimated that up to fifteen percent of sudden deaths are actually due to a pulmonary embolism.

Patients with deep vein thrombosis can get it through several mechanisms.  Common mechanisms include post surgery patients who have had lower leg, pelvic or low back surgery or who have surgery and are bedridden for a long time.  Travelers in planes for a long time, long bus rides, long car rides and even long train rides are at risk for getting a blood clot.  People who don’t move around a lot on such travels or who are elderly or who are smokers or on birth control are at higher risk of getting a blood clot from traveling or even from prolonged recumbency.   More rarely, patients with certain types of cancers or who have syndromes of hypercoagulability due to genetic reasons can have a greater risk of having a deep vein thrombosis or DVT. 

Common symptoms of a deep vein thrombosis include having one leg circumference larger than another with redness and induration of the leg.  There is often pain in the leg on the affected side and the superficial veins on that leg might be more engorged and prominent.  Doctors do a test called a “Homan’s” sign in which the dorsiflex (lift up at) the ankle and asks the patient if the pain in the back of the leg is worse.  If this is the case, it is considered a positive Homan’s sign. 

More technical tests for testing for deep vein thrombosis include doing a blood test for the presence of d-dimer.  A positive d-dimer blood test indicates that some sort of clotting is going on in the body and represents the presence of products of blood clotting.  This test is done when the clinician is just mildly suspicious of the presence of a DVT. 

The more definitive tests for a DVT include one known as the Doppler ultrasound of the leg, which looks at the leg veins under ultrasound to see if blood is flowing.  Another test is called a lower leg venous angiogram, which injects dye and sees if the veins are clear.  These are excellent tests that can prove the presence of a deep vein thrombosis.

If a person just has a DVT and it hasn’t gone to a pulmonary embolism or PE, the most common treatments are heparin by IV and oral Coumadin.  Both are blood thinners that don’t break up clots but prevent them from growing.  Natural processes allow the clot to break up on its own.  In severe cases, the person receives a medication called TPA or tissue plasminogen activator, which is considered a clot buster that actually dissolves the clot and clears up the problem more quickly.  As there are risks to giving TPA, it is only used in an emergency.

A pulmonary embolism (also called pulmonary embolus or PE) is considered a medical emergency in and of itself.  Too many clots in the lungs or just one big clot can easily be deadly to the patient.  The doctor often can’t find anything on examination except for the possibility of a friction rub heard when listening to the lungs.  A plain x-ray of the lungs is bound to be normal.  The doctor can be suspicious if the oxygen level in the blood is low, the patient is blue around the lips, breathing rapidly and is obviously anxious. 

Sometimes, if the suspicion is low, the doctor will just do a d-dimer test to see if there is clotting going on in the body.  If the suspicion is high, the test of choice is a dye study involving a CT scan of the chest.  In rare cases, an MRI of the chest can be done.  These tests are now done instead of the VQ scan, which used to be done on suspected cases of PE in recent years.

In many cases, the doctor must act fast to save the person with a pulmonary embolus.  Large clots interfering with oxygenation and tending toward sudden death need the use of tissue plasminogen activator or TPA.  If a surgeon is available, a pulmonary embolectomy is used to pull out the clot.  Smaller clots with a more stable patient are treated with IV heparin and oral Coumadin, in much the same way that DVTs are treated.  Both medications are started and when the Coumadin is at the proper level, heparin is stopped and the patient can go home if they are otherwise stable.  The patient may need to be on Coumadin for three months or more to keep the blood thin. 

The risks for pulmonary embolism are about the same as for DVTs.  Patients who smoke, who have cancer, or who are taking estrogen-containing birth control are at higher risk than the average person.  There are numerous genetic conditions you can inherit that will put you at greater risk for clotting of any kind.  If the blood clot comes from the arm, it is likely you have a genetic condition that is causing you to clot excessively and be at greater than average risk of DVT and PE.




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