Air Embolism Medical Malpractice

With intravenous therapy there is a risk of air embolism, that is, air bubbles entering the vein system from the failure to have the fluid fill up the entire plastic line prior to connection to the catheter or needle. Sometimes the intravenous bottle will run dry, and the nurse will connect another bottle without observing a substantial amount of air in the line. This air can cause damage by entering the heart, and if in a significant amount, obstruct blood flow through the heart into the lungs, somewhat like a blood clot in a pulmonary embolism.

The emergency treatment is placing the patient on their left side downward (with the body tilted in a leg upward, head downward position). This removes the air bubble from the tricuspid and pulmonic valve openings, allowing blood to go through its circuit to the lungs, while the air bubble is in a more innocuous position at the very bottom portion of the heart (apex), where it will be absorbed slowly over a few hours.

Sometimes a patient will have a congenital type of heart disease where there is a communication between the right atrium and left atrium, bypassing the filtering circuit of the lungs. Air entering the right atrium with this congenital heart defect can go directly into the left atrium when there is this "right to left" shunt flow of blood, and from there into the left ventricle and out into the aorta, the main artery of the body. If these air bubbles enter the cerebral circulation (the arteries to the brain) this will result in a stroke. Entering the blood vessels in other portions of the body usually is not serious as most areas of the body's flesh can withstand a number of hours of oxygen deprivation while the air bubbles are absorbed. The brain, however, can only withstand a few minutes of absence of oxygen before irreversible damage occurs.

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.

Deep Vein Thrombosis And Pulmonary Embolism Medical Malpractice Cases

Deep vein thrombosis (DVT) commonly affects the leg veins (such as the femoral vein or the popliteal vein) or the deep veins of the pelvis. Occasionally the veins of the arm are affected (if spontaneous, this is known as Paget-Schrötter disease). A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, red, warm and the superficial veins may be engorged.

The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, which is called a pulmonary embolism (PE). DVT is a medical emergency; present in the lower extremity there is 3% chance of a PE killing the patient.

Blood clots form in leg veins, break off and travel through the larger veins into the inferior vena cava, through the right atrium (blood receiving chamber of the heart), through the tricuspid valve into the right ventricle where it pumped under force through the pulmonic valve into the pulmonary (lung) artery. There it lodges like a cork blocking unoxygenated blood to that segment of the lung. Often small clots break off from the leg veins over time and then a very large clot which can block the heart/lung circuit causing death.

Post-operatively did the patient have anti-embolism elastic stockings ordered by the Surgeon and put on by the nurse? Were they used for every bed bound patient? Lying in bed causes blood to stagnate in the leg veins. Were the nurses encouraging the patient to exercise their legs in bed, particularly their feet /ankles up and down every hour? This motion caused by their leg muscle contractions, forces blood to move faster through their veins and reduces the risk of clotting.

The elastic bandages compress the superficial veins forcing more blood to flow faster through the deep veins, where the greater risk of clotting occurs.

Also, in high-risk immobile patients the use of an injectable blood thinner (anticoagulant), heparin at 5,000 units, twice a day, also reduces that risk without significantly increasing the risk of bleeding.

With chest pain occurring in such a high-risk patient, the diagnosis of a pulmonary embolism must be considered and ruled out. Was a Spiral CT ordered, Blood gases, ankle pumps, regular blood tests to determine therapeutic status of anti-coagulation done, was there a consult with a pulmonary specialist?

With the diagnosis made, therapeutic doses of heparin (anticoagulant drug) are given to decrease the clotting ability of the blood as measured by the partial thromboplastin time (PTT) test. This drug is usually continued for 5-10 days after the symptoms are gone, and then the patient is converted to the oral anticoagulant Coumadin (warfarin) for 6 months to one year.

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.