Watch the video below to learn more about blood clot and pulmonary embolism management negligence.
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Video Transcript
Timestamps
0:00 Intro
0:28 The Most Common Causes Of Death In America
0:47 The Most Common Causes Of Death Due To Medical Negligence
1:46 Preventable Deaths From Blood Clots
2:53 Diagnosis Determined By Detailed History
3:08 Diagnosis Determined By Careful Physical Examination
3:21 Diagnosis Determined By Testing As Indicated By HX & PE
5:01 German Pathologist – Rudolf Virchow
7:21 Stasis From The Heart
9:02 What Is A Pulmonary Embolism?
10:18 Hypercoagulable State
15:14 Prevention Of PE (Pulmonary Embolism)
16:33 2% Of Doctors Account For
My name is Kenneth C. Chessick, MD. I’m a trial lawyer as well as a general surgeon and a surgeon who has done cardiovascular, heart, and lung surgery as well. My law practice is devoted entirely to the representation of victims of medical negligence.
0:28 The Most Common Causes Of Death In America
The most common causes of death in America are number one, cancer, number two, medical errors, and number three, cardiovascular disease, which includes diseases and problems of the heart, blood clots both in the legs into the lungs, and stroke.
0:47 The Most Common Causes Of Death Due To Medical Negligence
Now, the most common causes of death due to medical negligence are the delaying diagnosis and treatment of cancer, that’s number one. But the second most common cause of death from medical negligence is the failure to diagnose and treat diseases of the heart and lungs. And that includes the failure to diagnose and treat blood clots, heart attacks, and strokes.
All deaths from medical negligence are one hundred percent preventable. Death from negligence should never ever occur. By definition, it’s the failure of a doctor to act like a reasonably careful doctor in making the diagnosis and treating the patients.
All medical negligence deaths are preventable and that includes deaths from blood clots, which is the main topic of today’s discussion.
1:46 Preventable Deaths From Blood Clots
The prevention of blood clots is something that can be, must be done when it’s predicted, and you can always predict when most blood clots are going to occur because they occur almost always in high-risk people. If you identify the patient who’s at risk for a blood clot, you can prevent it and when it occurs, you can treat it. By doing that, you can save a life. If you don’t make the diagnosis of people who are prone to blood clots and a blood clot develops, with no treatment that patient frequently will die, and that is a preventable death. All diagnoses, whether of cardiovascular disease, blood clots or cancer, or everything else are made in three very important ways.
2:53 Diagnosis Determined By Detailed History
The most important part of making a diagnosis is to take a physician or treating individual and must take a detailed history, ask a bunch of questions of the patient, and then ask follow-up questions based upon their responses.
3:08 Diagnosis Determined By Careful Physical Examination
The second most important part is a detailed careful physical examination. Physical detailed history will give you the clue to the diagnosis. Eighty percent of the time physical examination will add another fifteen percent.
3:21 Diagnosis Determined By Testing As Indicated By HX & PE
And then testing, which can confirm the clinical impressions, picks up the remainder. In order to take a detailed history, however, it’s a time-consuming task. The conduct of the physician and that’s by the way, we’re always talking about the conduct of the health care provider. It’s time-consuming sitting there with a patient, taking a detailed history, asking questions, listening to the answers, and then asking follow-up questions depending upon the responses. It just takes time and thought and effort, and unfortunately, negligent doctors don’t want to spend that time. It’s not that they don’t have the knowledge, the vast majority of the time they do. They just didn’t take the time to do that.
Similarly, a physical examination takes time. It’s something that you do one-on-one with the patient. You use your five senses of vision, touch, smell, and hearing. Usually, you don’t use taste but look at the patient. Sit, understand what you’re seeing, touch them, and feel the areas that are involved. That’s the key to making all physical examinations.
Blood clots have been around for centuries. Back in the 1870s, there was a German pathologist by the name of Rudolph Virchow who identified the situations in which blood clots occur and they now bear his name.
5:01 German Pathologist – Rudolf Virchow
They’re called Virchow’s Triad and it involves stasis or lack of flow of the blood, trauma, and what’s called hypercoagulable state conditions, which predispose the patient to forming blood clots. Now, these were true in the 1870s, they’re true in the 21st century.
Now when we talk about stasis, we’re talking about the fact that the blood in the veins and blood clots almost always arise in the veins of the legs and the pelvis, occasionally in the heart. But it almost always occurs because the blood is not flowing. Frequently, that’s a result of lack of movement of the legs or lack of movement of the patient. That may happen to people who are at prolonged bed rest. If they don’t have their leg muscles contracting and pumping the blood that will keep the blood flowing back to the heart, that blood sits around and it can form blood clots. We see it in long-haul drivers, we see it in salesmen who spend a lot of time in the car. I’ve even seen it in people on airplanes. There are certain conditions that lead to stasis or lack of free-flowing of the blood.
Varicose veins are one example, which are those veins that pop out in people’s legs when the valves in those veins don’t work properly. Those can also predispose to blood clots. Sometimes there’s an abnormal communication between an artery and a vein in the legs or elsewhere and it’s called the EV fistula, an arterial-venous fissure that can cause some stasis.
Patients who have in addition to being in bed because of dehability, post-operative situations, people have had casts placed on their extremities, on their lower extremities, that also creates stasis and that’s one-third of work australia. You don’t need all three to develop a blood clot. Any one of those things can do that.
7:21 Stasis From The Heart
We see stasis in certain conditions of the heart. Atrial fibrillation, which is a circumstance when the upper chamber of the heart doesn’t contract properly, blood can sit around in certain parts of the atrium. It’s called the atrial appendage and they can form clots. So rather than a blood clot forming in the legs or the pelvis, it can form in the heart. That’s well-known and in fact, that’s a major cause of morbidity and mortality in people with atrial fibrillation. It can be other things, things like in-dwelling, foreign materials in the heart, an abnormal mechanical heart valve, or a pacemaker that’s inserted through the veins into the inside of the heart. Certain kinds of wires and tubes and devices. Those all, these foreign bodies can result in stasis of the blood around those devices.
Clots forming and other situations where blood stasis occurs is a heart attack. Sometimes a clot can form on the wall of the inside of the left ventricle of the heart where there’s been some previous injury to the heart as a result of a heart attack, clots can form there.
The problem with all of these clots is that they can break off and blood flow when in the veins returns to the heart and then is pumped to the lungs.
9:02 What Is A Pulmonary Embolism?
When these blood clots are pumped to the lungs, that’s called a pulmonary embolism. Pulmonary embolism is a major cause of death in all patients, all patient groups, and so it’s very very important to identify people who are at risk for blood clots and therefore from pulmonary embolism.
Other pieces of history that you can identify, of course, is if the patients had trauma to their body parts, crushing injuries, or penetrating injuries, gunshot wounds, automobile accidents, surgical operations, broken bones on the pelvis and the hip, and the upper bones of the thigh, the femurs, those all can predispose to the formation of blood clots. In fact, anything that injures the lining of the veins which is the tubes that bring the blood back to the heart and then from there to the lung, anything that interferes with the integrity of the lining of the veins, the clots predisposes the blood to clot and when clots conform, that means they can break off and develop pulmonary emboli.
10:18 Hypercoagulable State
Other historical things that carefully detailed history will determine is whether the patient has what Virchow called a hypercoagulable state. There are certain conditions which predispose to blood clotting. One of the most common is cancer of course. All kinds of cancers, especially solid cancers that come to the breast and the lung, and the liver, can all increase the ability of blood and the propensity of blood to clot. Diseases of the blood, particularly white blood cells, that frequently can cause problems with clotting, increasing the coagulability of the blood and increasing the likelihood of a blood clot forming, and therefore, pulmonary embolism.
Certain conditions of increasing numbers of red blood cells, the little cells in our blood that carry the oxygen, some patients with lung diseases like emphysema or people who live at high elevations, they actually can increase the number of red blood cells in their system and that increases the propensity of blood to clot. That condition is called polycythemia.
You can have conditions like leukemia and lymphoma and anything that increases the number of platelets. Trauma itself increases the number of platelets. Platelets are the part of the blood that is part of the system that forms clots. So history is critical and that’s why I’m spending so much time on this because this is the most common flaw, error, negligent error that doctors can make, which can overlook that. Both the prevention of blood clots as well as the diagnosis and treatment when they do occur, and both are extraordinarily important.
Blood clots can be prevented in many patients, not all. But in many, what do you do? Well, we all know after surgery we try to mobilize patients, and get them walking as soon as they can. Today’s hip surgery used to be a major cause of blood clots and it still is. But many patients after hip operations are mobilized and get up walking the day of surgery. The sooner you can mobilize the patient and prevent them from sitting, lying in bed all day long stasis, especially superimposed with hypercoagulable states from trauma or surgery. That’s so important.
We use compression stockings and pneumatic compression devices, which help pump the blood in the legs and people that have to be at bed rest. Whether or not compression stockings work is open to debate. But there are other conditions we talked about. Varicose veins are another one. Varicose veins are conditions where the veins and the legs pop out and what’s happened is that the valves in those veins have stopped functioning properly and the veins dilate and blood doesn’t flow rapidly through those varicose veins, and that can lead to blood clots. Blood clots, skin can lead to blood clots inside the muscles and those are particularly risky because those are the ones that can break off and go to the heart.
Those are some of the preventive things that we can do but there’s medications as well. Heparin, of course, is the mainstay of anticoagulation. Heparin is a medication which prevents blood from clotting. In administering, watch the dosage of it because too much can be depleting but the failure to treat somebody with heparin or both prophylactically to prevent a blood clot or when they do actually get it, is negligence that can lead to death. There are other drugs, low molecular weight. Dextran is another one that’s given. There’s oral medications, coumadin which is an anticoagulant which prevents blood from clotting. Eliquis is another one. There are other ones as well. Plavix is something that affects the platelets as does aspirin and are used in circumstances like that as well. So these are all of the things that can be done to prevent a blood clot in the legs or the pelvis or elsewhere and which can break off and lead to fatal pulmonary emboli.
15:14 Prevention Of PE (Pulmonary Embolism)
With prompt diagnosis and treatment, most deaths can be prevented and avoided. Medical negligence, I’m going to say this again, is one-hundred percent preventable. Deaths from medical negligence should never occur. By definition, that means that this doctor or healthcare provider was not acting like a reasonably careful person of similar training in the same or similar circumstances. That should never occur. They don’t have to be the best, the smartest. They just have to be as good as what a reasonably careful doctor would do in the same circumstances. They can all be prevented and that’s really critical.
Now, I want you to know that medical negligence is really only, especially resulting in death from pulmonary emboli, only happens to a very small percentage of doctors. The vast majority of physicians do not commit medical negligence. They act like a reasonably careful doctor would do in the same or similar circumstances. But there is a cadre, a small country of negligent doctors and oftentimes, they’re sued multiple times.
16:33 2% Of Doctors Account For
Fewer than two percent of all doctors are responsible for more than fifty percent of all reported settlements from medical negligence, and one percent of physicians are responsible for one-third of all paid claims. Medical negligence should not occur. The deaths from medical negligence from blood clots going from the legs to the lungs should not occur. There are other treatments we haven’t talked about, things like filters that you can put in, but the point is that these things should never occur.
If you want to talk about this further, please give me a call. I’d be happy to discuss your case with you. Thank you.
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