DVT Prophylaxis Never Utilized Which Results in Deadly Pulmonary Embolism

Case Overview

Questions to the Critical Care Medicine expert and their responses

What precautions should have been taken with this type of patient?

A patient with a hematoma would not be a candidate initially for anti-coagulation. Once there was no further evidence of bleeding, and ideally, the cause of the hematoma understood, prophylactic dosages of subcutaneous heparin or low-molecular weight heparin could be administered to prevent deep venous thrombi (DVT) in a bedridden patient at risk for this common disorder. In a patient with increased risk of DVT who has a relative contraindication for anti-coagulation, sequential compression devices (SCD's) could have been used to decrease his risk of DVT and subsequent PE. This device could have been used upon his admission to the hospital.

What should have been considered once he became short of breath and developed leg swelling?

Once he became short of breath and developed leg swelling, pulmonary embolism should have been considered and a diagnostic study performed. PE is a major killer in this country and most deaths occur without an antemortem diagnosis and the opportunity for effective treatment.

About the expert

Based in Denver, CO, Dr. Schwartz is a graduate of the University of Michigan (BA & MD). He completed his residency in internal medicine at Michael Reese Hospital and Medical Center in Chicago and his fellowship in pulmonary medicine at UCSD Medical Center in San Diego. Dr. Schwartz is board certified in pulmonary medicine, internal medicine and critical care medicine and has more than 30 years experience actively treating patients for pulmonary and respiratory issues. He currently manages Colorado Pulmonary Associates, a private practice, and serves as director of respiratory therapy at St. Lukes Medical Center in Denver,