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If a family member has died as a result of a delay in the diagnosis or treatment of a pulmonary embolism.
Facts & Figures
- Deaths from Pulmonary Embolism are the
leading form of accidental death for
hospitalized patients, and the second
most common cause of unexpected death
in the general population.
- Over 200,000 deaths will occur in the
U.S. this year as a result of Pulmonary
- The most common cause of Pulmonary
Embolisms are Deep Vein Thrombosis (DVT).
- Approximately one in twenty people develop
DVT during their lifetime.
- Approximately 60,000 hospitalizations for
DVT will occur in the U.S. this year.
What is a Pulmonary Embolism
A Pulmonary embolism occurs when there is a blockage of
the blood vessels in the lungs. Although a pulmonary
embolism can be caused by air bubbles, fat droplets,
amniotic fluid, or even clumps of parasites or tumor
cells that obstruct the pulmonary vessels, they most
often result from Deep Vein Thrombosis (DVT) - blood
clots (thrombus) from the veins, especially veins in
the legs or in the pelvis (hips). If the thrombus, or
a piece, breaks free it can be carried through the
vessels and the heart until it gets to a point where
the vessel is too narrow, usually in the pulmonary
artery or one of its branches. The clot (called an
embolus once it breaks free) can then completely block
the vessel and prevent blood from moving past it to
the lung (called a pulmonary embolism). Thus, while the
affected section of lung continues to be ventilated
(supplied with air), it is not perfused (supplied with
blood). This leads to acute respiratory distress and
heart failure or cardiogenic shock, resulting in death
or serious damage to the lungs.
When smaller clots lodge in a branch of the pulmonary
artery, there may be few symptoms other than increased
heart rate or shortness of breath. However, repeated
episodes of smaller Pulmonary Embolism over time, can
cause pulmonary hypertension, right heart failure, and
Risk Factors of Pulmonary Embolism
Risk factors for pulmonary embolisms include the following:
Persons with certain clotting disorders may also have a
- Prolonged bed rest or inactivity (including
long trips in planes, cars, or trains);
- Oral contraceptive use;
- Surgery (especially pelvic surgery);
- Massive trauma;
- Stroke ;
- Heart attack;
- Heart surgery; and
- Fractures of the hips or femur.
Warning Signs and Symptoms of DVT and Pulmonary Embolism
The most common symptoms of lower extremity DVT are swelling
and pain. The skin may become discolored and the patient
may also have a low-grade fever. If those symptoms are
present in a patient who has been bed-ridden or convalescing
from surgery, or who has been non-ambulatory for some other
reason, or who has other substantial risk factors for DVT,
then the patient's physician should consider and rule out a
diagnosis of DVT.
The symptoms of a Pulmonary Embolism in many cases include
one or more of the following:
- chest pain
- under the breastbone or on one side;
- especially sharp or stabbing; also
may be burning, aching or dull, heavy
- may be worsened by breathing deeply,
coughing, eating, bending, or stooping;
- acute onset of shortness of breath at rest or
- fainting or dizziness;
- tachypnea (rapid breathing);
- tachycardia (rapid heart rate)
- with sudden onset or
- producing bloody sputum;
- sweating and
Other possible symptoms include: wheezing, clammy skin, bluish
skin discoloration, nasal flaring, pelvic pain, leg pain in
one or both legs, swelling in the legs, a lump associated with
a vein near the surface of the body (superficial vein) that
may be painful, low blood pressure, anxiety.
Diagnosing DVT and Pulmonary Embolism
Diagnostic testing for DVT includes a through physical
exam (including testing for "Homan's sign" - pain in
the calf muscles upon forced dorsiflexion of the foot
with the knee straight), and a Doppler ultrasound, in
which sound waves are used to estimate blood flow
through the veins so as to determine whether a clot
may be partially or completely occluding a segment of
the vein. A venogram involves injection of dye that
can be seen on x-ray. An MRI can also disclose the
existence of DVT, although its use is not yet
widespread for that purpose.
Because symptoms of a Pulmonary Embolism are non-specific,
specific diagnostic tests are necessary to rule out a
Pulmonary Embolism. The three most common tests are a
pulmonary angiography, a nuclear lung scan (VQ scan), and
a spiral CT scan (which involves injecting iodines dye
into a vein while the patient is scanned in a spiral CT
Treating DVT and Pulmonary Embolism
Treatment of DVT involves the use of anticoagulant
medications, such as heparin and Coumadin, to
prevent extension or propagation of the clots, and
to avoid pulmonary embolism. Coumadin is generally
administered for six months. In cases where a
patient has a coagulation disorder, Coumadin may
be given on a life-long basis in order to avoid
Once the patient suffers a Pulmonary Embolism,
emergency treatment and hospitalization are necessary.
In cases of severe, life-threatening pulmonary
embolism, treatment requires that the clot be
dissolved with thrombolytic therapy. Thrombolytic
therapy (clot-dissolving medication) includes
streptokinase, urokinase, or t-PA. Anticoagulant
therapy prevents the formation of more clots and
allows the body to re-absorb the existing clots
faster. Anticoagulation therapy (clot-preventing
medication) consists of heparin by intravenous
infusion initially, then oral warfarin (Coumadin).
Subcutaneous low-molecular weight heparin is often
substituted for intravenous heparin in many
circumstances. In patients who cannot tolerate
anticoagulation therapy, an inferior vena cava
filter (IVC or Greenfield filter) may be placed
to trap clots that break off from DVT. This device,
placed in the main central vein in the abdomen, is
designed to block large clots from traveling into
the pulmonary vessels. Oxygen therapy may be
required to maintain normal oxygen concentrations.
To prevent recurrent DVT that could lead to a
Pulmonary Embolism, a physician may also recommend
that the patient use graded elastic stockings.
Surgery may be indicated in patients at great risk
for recurrent embolism.
Prophylactic therapies may also be used in patients
who undergo surgery and have risk factors for DVT.
Because prophylactic medications such as heparin or
Coumadin, involve an increased risk of bleeding, they
and may not be appropriate for some surgery patients.
Other measures, such as the use of pneumatic
compression stockings, may thus be used during
surgery and the post-operative periods, in place of,
or in addition to medications. Leg and calf muscle
exercises and graduated compression stockings (TED
hose) can also used.
Prognosis Without Treatment
Without effective treatment, the rate of recurrence
of DVT and Pulmonary Embolism may be as high as 50%,
and Pulmonary Embolism mortality may reach 30%. The
risk of death increases with each recurrent episode
of Pulmonary Embolism. With timely diagnosis and
treatment, the rate of recurrence and mortality is
Any undue delay in diagnosing or treating DVT or
Pulmonary Embolism can have tragic consequences.
Unfortunately, too often
warning signs are ignored, and treatment is delayed.
The following are among the more common forms of
negligence or medical malpractice by physicians and
other health care providers in
diagnosing and/or treating patients with DVT or a
The above are only examples and are by no means intended
to be an exhaustive list of acts of malpractice.
- Failing to test for DVT or Pulmonary Embolism
in the presence of warning signs or symptoms
- Delaying the diagnosis of DVT or Pulmonary
- Failing to order appropriate treatment for
a patient with DVT or Pulmonary Embolism
- Failing to follow-up with the patient
If someone you know has died or suffered significant
injury to the heart or lungs due to complications of
DVT or Pulmonary Embolism as a result of the neglect
of a physician or other health care provider, you
should immediately contact a competent attorney.
The attorney will work with you to determine legal
options that may be available.
Call or email for a Free Attorney Consultation
Law Office of Joseph A. Hernandez, P.C.
Phone: (781) 461-9400
Toll Free: (866) 461-9400
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