Pulmonary Expert Witness

Pulmonary medicine, or pulmonology, is a medical speciality that focuses on treating lung and respiratory diseases. It can also be called chest or respiratory medicine. A common disease that pulmonologists are concerned with is tuberculosis.

One of AME’s pulmonary expert witnesses has written an exclusive medical malpractice article that we have provided, for your interest, below. 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.