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Why are health practitioners missing diagnosing Pulmonary Embolisms?
The medical negligence team at Wilson Browne have had an increased number of enquiries recently about delayed diagnosis of pulmonary embolisms, so here are 7 things you should know.
What is a Pulmonary Embolism?
A pulmonary embolism is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the blood stream. In other words a blood clot, usually formed in the legs due to Deep Vein Thrombosis, travels to the lungs and causes a blockage. A pulmonary embolism can be life threatening as the clot blocks the blood flow to the lungs and therefore early diagnosis is vital.
If you experience chest pains or pain in the upper back, difficulty breathing or coughing up blood, you should consult your GP. There may be other explanations for the presence of these symptoms, not necessarily a pulmonary embolism but they also should not be ignored. However, if you have severe difficulty breathing, your heart is beating rapidly or you pass out, you should call 999 or attend A&E as these can be the first signs of a pulmonary embolism.
The symptoms can vary depending on how much of the lung is involved, the size of the clots and whether or not an individual has underlying heart or lung disease. However, many people suffering from a pulmonary embolism will experience the following:-
-Severe difficulty breathing
-Leg pain or leg swelling or both, usually in the calf.
-Clammy or discoloured skin
-Dizziness or light headedness
The cause of a pulmonary embolism is often unknown and can happen for no obvious reason. The chances however can increase in individuals who have been inactive for a long period of time and it is thought that half of the population who develop a pulmonary embolism do so whilst they are in hospital and usually immobile.
Reducing the Risk
Reducing the risk of a pulmonary embolism is focussed around taking measures to reduce the risk of Deep Vein Thrombosis (DVT). This is because, as aforementioned, pulmonary embolisms usually occur when part of the blood clot in the leg dislodges itself and travels up to the lungs causing the blockage.
DVT can develop on journeys usually lasting 6 hours or more and therefore precautions should be taken on long journeys especially if you are at risk of DVT. To reduce travel related DVT you can:-
-Ensure you are sitting comfortably and lie back as much as possible
-Wear loose fitting clothing
-Have plenty of leg room
-Drink water regularly
-Take regular breaks from sitting where possible
-Bend and straighten the legs, feet and toes every 30 minutes
-Press the balls of the feet down hard on the floor regularly
-Wear flight/travel socks
If a pulmonary embolism is suspected, a number of tests should be carried out to confirm it or rule it out. Tests include:-
-Pulmonary angiogram-the most accurate way to test for a pulmonary embolism
-Chest X-rays to rule out conditions that mimic the disease
-An Ultrasound scan to detect a clot in the leg which may travel
-Lung function tests
-Blood test to look for a protein called D-dimer-this is a protein that will be present in the blood when there is a major clot.
Pulmonary embolisms, if detected early, can be treated with anticoagulants (blood thinners). These drugs prevent further clots whilst the body works to break up the original clot.
Thrombolytic drugs (clot dissolvers) can also be used in more severe cases where the clot needs to be dissolved as quickly as possible.
Deep Vein Thrombosis - Case Study
Wilson Browne’s specialist Medical Negligence team acted for a lady on behalf of her late husband in pursuing a claim against Kettering General Hospital Foundation Trust for the substandard treatment he received.
This gentleman had a history of arthritis in both his knees due to which he was receiving steroid injections. He attended the Accident and Emergency Department at Kettering General Hospital due to suffering severe pain and swelling in his knees which caused him difficulty in mobilizing. Following examination by a junior doctor he was also prescribed with antibiotics due to a possible infection and advised to take regular analgesics for his knee pain and discharged that day.
A week later, this gentleman returned to the Accident and Emergency Department at Kettering General Hospital with increasing left leg pain and swelling. During his admission, a Venous Thromboembolism Assessment was performed which assessed him as being at significant risk of developing a Deep Vein Thrombosis (DVT) and therefore he was prescribed with thromboprophylaxsis medication namely Enoxaparin mediation 40mg daily and the plan was to continue him on thromboprophylaxsis medication for the prevention of a DVT from occurring. He remained in hospital for two weeks during which time examinations and tests were carried out by an Orthopaedic Consultant.
Subsequently, due to continued pain and swelling of his knee, this gentleman had his knee aspirated and underwent three arthroscopic knee washout procedures and was later discharged home. However, despite the risk of him developing a DVT, he was not advised to take thromboprophylaxsis medication and neither was he advised appropriately about the risks associated with not wearing AES stockings for the prevention of a DVT.
Approximately two weeks later this gentleman attended the Accident and Emergency Department at Kettering General Hospital due to suffering an acute episode of chest pain and breathlessness. A diagnosis of Pulmonary Embolism was made, his condition deteriorated and sadly he passed away the next day. The cause of his death was established as being Deep Vein Thrombosis, Pulmonary Embolism and Septic Arthritis.
The claim was pursued on the basis that there were significant failures by Kettering General Hospital by discharging this gentleman upon his initial attendance to the hospital without examination by a Consultant Orthopaedic Consultant and failing to recognize a potentially infected knee. We alleged that had his knee infection been recognized earlier and managed appropriately then he would have avoided additional pain and suffering and the subsequent arthroscopic knee washout procedures. We further alleged that there were failures by the hospital in the management of this gentleman’s treatment for the prevention of his DVT by failing to provide the correct doses of thromboprophylaxsis medication, and the failure to advise him of the risks of not wearing AES stockings. We asserted that had this gentleman’s thromboprophylaxsis medication been appropriately managed then he would have avoided developing a DVT and subsequent pulmonary embolism that ultimately led to his sad death.
We investigated this Claim and relied on evidence from a Consultant Haematologist and a Consultant Orthopaedic Surgeon. The case progressed as Kettering General Hospital continued to deny negligence and subsequently proceedings were issued.
Wilson Browne secured a five figure sum in compensation for the pain and suffering that this gentleman went through which sadly led to his death