Posted by Bill Sandweg on 30 September 2019.
Pulmonary embolism is a medical condition in which blood clots form in the return, or venous, circulation and are passed by the heart into the lungs where they interfere with oxygen exchange. The larger the clot or the greater the number of clots, the greater the degree of interference. Symptoms can range anywhere from mild to severe shortness of breath. When patients go to the doctor or hospital with symptoms of pulmonary embolism and are not treated properly, great harm, up and including death, can result. Malpractice suits often follow.
I have handled a number of pulmonary embolism cases over my career. All of them involved the death of the patient. Patients can be failed by the medical system in a number of ways but the most common is the failure of the doctor to recognize and diagnose the pulmonary embolism. One of my cases involved a man in his 60’s who went to the emergency department with significant shortness of breath. After working him up, the emergency department physician diagnosed him with a cold and sent him home. By the time he returned the following day, he was at death’s door and it was too late to save him.
Those who have studied this problem consistently state that doctors seeing patients who are short of breath must have a high “index of suspicion” that they may be seeing pulmonary embolism and test for it. Most often the source of the blood clots is a larger clot in the deep veins of the leg. This is called a deep vein thrombosis or a DVT. Pieces break off the large clot and travel to the lungs where they become trapped in the small vessels where the lung exchanges CO2 for oxygen. Once they become trapped, they prevent any further flow of blood into the portion of the lung downstream from their location. The larger the clot, the sooner it becomes trapped and the greater the portion of the lung which is put out of commission. If a very large piece of clot breaks off, it has the potential to become trapped at the very top of the lungs and cause death within minutes.
Once doctors recognize the presence of pulmonary embolism, the most common form of treatment is the administration of anticoagulants to keep the blood from clotting and to gently break up the clots that are already present.
There are, of course, other ways for doctors to make mistakes that cause or allow a patient to develop pulmonary embolisms. One of my cases involved a man who had known problems with blood clots in his legs and was on regular blood thinners to prevent clot formation. Unfortunately, he needed a hip replacement. You cannot have a hip replacement while taking blood thinners so they had to be stopped prior to the surgery. There was a lack of communication between the orthopedic surgeon who performed the procedure and the doctor who saw the patient in the hospital after the procedure and who discharged him. Because of the lack of communication, the patient’s blood thinner medication was not restarted when he was discharged. A few days later, his wife returned to the house to find him dead on the floor. A massive clot had formed in his leg and traveled to the lungs. Another death which never should have happened.
Still another form of malpractice occurs when a patient is on blood thinners for a while because of DVT and the doctor takes the patient off the blood thinners too soon and the DVT reoccurs.
There is not much patients can do to avoid being injured by pulmonary embolism. The best advice is to remain hydrated, to be alert to pain in the legs which might mean a DVT is present and to make sure doctors don’t forget about your anticoagulant prescription, if you have one and it has to be temporarily stopped while you have an operation.