Posted by Bill Sandweg on 10 December 2018.
Over the years, I have handled a number of medical malpractice cases involving pulmonary embolism, often called “PE.” Each case involved a needless death. PE is an insidious and sometimes fatal condition that is sometimes missed by doctors. Most of the PE cases I have handled involved a failure to diagnose.
A pulmonary embolism is a blood clot that enters the lungs. It usually begins with a clot in the deep venous circulation of the leg. These clots are called DVT’s for Deep Venous Thrombosis. The leg clot may throw off pieces, which travel along with the venous blood on its way back to the heart. A piece of clot which is cast off is called an embolus. When the clot and the venous blood reach the heart, they enter its right side. From there the heart pushes them into the lungs, where the blood gives off its carbon dioxide and takes on oxygen before returning to the heart and being sent throughout the body.
When an embolus gets to the lungs, it continues to travel along with the venous blood. The lung vessels through which it travels get smaller and smaller as the blood moves along. At some point, the vessel is too small for the clot to continue and it gets wedged in the vessel. Once it gets wedged, it acts like a dam. It prevents any blood from getting past it to be reoxygenated. What happens next depends on the size and number of the emboli.
There may be one piece of clot thrown off by the main clot in the leg or as many as hundreds in what are called “embolic showers.” The clots may vary in size. Some may be large. Some may be quite small.
If the clot is large enough, it can block all flow of blood to the lungs. These large clots, sometimes called “saddle” emboli, cause death within minutes. There is never time to get the patient to the hospital for treatment of a clot this size and they die where they fall. The larger the clot, the sooner it will become wedged and the more lung it will block. On the other hand, if the clot or clots are small enough and few enough, the patient may never realize that there is a problem.
If pulmonary emboli are allowed to remain in the lungs and the patient does not die, the clot will eventually dissolve. Even small clots may be fatal, however, if there are enough of them. As small clots continue to shower down on the lungs, they gradually block more and more of the lung and the patient has a harder and harder time breathing until finally there is not enough lung left unblocked to sustain life. These are the cases that cause unnecessary death.
Once a person has had a DVT, they are at increased risk to have another. DVT’s are most common when someone has been inactive for a while and the blood in the legs does not circulate as it would if they were walking around. Long air trips where a person is forced to remain seated with their legs below them have been shown to put people at increased risk for DVT. Prolonged bed rest puts a person at increased risk for DVT. If you are taking a long air trip, get up and walk around the cabin from time to time and keep yourself hydrated.
If you are having trouble breathing, see the doctor as you may have PE. If your breathing gets worse and worse, you may have PE. Ask your doctor about PE in these circumstances and, if you have it, hope he or she diagnoses it in time. Good luck.