Failure to Diagnose & Delay in Treatment of Pulmonary Embolism (Embolus, Blood Clot)

Evaluate breaches in the standard of care when investigating Failure to Diagnose & Delay in Treatment of Pulmonary Embolism (Embolus, Blood Clot)

Answer the following questions to find out if the standard of care was followed for your case.

  • Did the patient have risk factors for venous thromboembolism?
    Yes
    No risk factors present
    Why is this important?
    Data suggests that most patients with first-time venous thromboembolism have one or more recognized risk factors.
    (2012) 30 EMDCNA 2 329-375

  • With which of the following symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Pulmonary embolism can be difficult to diagnose correctly because of the lack of specific signs and symptoms.
    (2003) 24 ECLCMD 1 13-28

  • Was a physical examination performed on the patient? Why is this important?
    Answer this question
    Pulmonary embolism can present with varying degrees of severity, ranging from asymptomatic (detected incidentally on imaging) to hemodynamic instability and sudden death.
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  • With which of the following physical signs did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    The signs of pulmonary embolism include tachypnea, tachycardia, reduced breath sounds, accentuated pulmonic component of second heart sound, wheezing, low-grade fever and pleural friction rub with a peripheral pulmonary infarct. Tachypnea is the most frequent sign.
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  • Was pulmonary embolism considered as a possible diagnosis? Why is this important?
    Answer this question
    Pulmonary embolism is a life-threatening condition. Patients in whom pulmonary embolism is suspected should be promptly evaluated, undergo appropriate diagnostic testing, and receive anticoagulant therapy if the diagnosis is confirmed.
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  • Was the patient discharged from the medical facility without undergoing further investigations? Why is this important?
    Answer this question
    Patients in whom pulmonary embolism is suspected, must be promptly evaluated, undergo appropriate diagnostic testing and receive anti-coagulant therapy if the diagnosis is confirmed.
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  • What was the patient’s pre-test probability (PTP) of pulmonary embolism? Why is this important?
    Answer this question
    Clinical prediction rules stratify patients into low, moderate, or high pretest probability of pulmonary embolism categories, which, in turn, helps to determine the need for further diagnostic testing.
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  • Which of the following routine investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    Once the pre-test probability of pulmonary embolism is determined, further studies must be selected and performed.
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  • Was a D- Dimer test performed? Why is this important?
    Answer this question
    A D-Dimer evaluation is a venous blood sample analysis used as a primary diagnostic study for all patients suspected of pulmonary embolism.
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  • Was the patient started on heparin before further investigations? Why is this important?
    Answer this question
    Empiric parenteral anti-coagulation is recommended during the diagnostic evaluation of patients in whom there is a high clinical suspicion of acute pulmonary embolism.
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  • What was the result of the computed tomographic pulmonary angiography (CTPA) or the ventilation perfusion lung scan (VQ Scan)? Why is this important?
    Answer this question
    When the CTPA is positive, or a high probability of pulmonary embolism is found in the VQ scan, treatment must be initiated immediately.
    (2012) 30 EMDCNA 2 329-375

  • Was periodic follow-up advised? Why is this important?
    Answer this question
    Following discharge, initial monitoring must be frequent to ensure that anti-coagulation therapy is adequate and stable.
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  • Were anti-coagulants contra-indicated for the patient? Why is this important?
    Answer this question
    The primary prophylaxis in the prevention of fatal pulmonary embolism is the use of either drugs (anti-coagulants) or physical methods that are effective for preventing deep vein thrombosis. For patients in whom anti-coagulants are contra-indicated, physical prophylactic methods are utilized.
    (2012) 30 EMDCNA 2 329-375

  • Were compression stocking prescribed? Why is this important?
    Answer this question
    For patients in whom anti-coagulants are contra-indicated, physical prophylactic methods such as intermittent pneumatic compression (IPC) and graduated compression stockings are recommended to prevent pulmonary embolism.
    (2012) 30 EMDCNA 2 329

  • Was heparin administered to the patient? Why is this important?
    Answer this question
    The treatment of acute PE is systemic anti-coagulation with or without thrombolysis. Heparin is a very effective anticoagulant. Anti-coagulation halts clot progression.
    (2012) 30 EMDCNA 2 329-375

  • Was a venous compression ultrasound (CUS) performed? Why is this important?
    Answer this question
    A venous CUS must be considered as an initial imaging modality in patients with concomitant signs and symptoms of DVT and contra-indications to VQ or CTPA.
    (2012) 30 EMDCNA 2 329-375

  • Was the ultrasonography of the leg veins (CUS) positive for DVT? Why is this important?
    Answer this question
    Patients without evidence of DVT upon CUS evaluation are at low short-term risk of pulmonary embolism and do not require anti-coagulation.
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  • Was follow-up serial ultrasonography performed? Why is this important?
    Answer this question
    Patients without evidence of DVT upon ultrasonography have a low short-term risk of pulmonary embolism and do not require anti-coagulation, however they require follow-up compression ultrasound (serial ultrasonography).
    Click here for additional information at ClinicalKey.com

  • Did the patient have contraindications to CTPA/VQ scan? Why is this important?
    Answer this question
    A venous CUS must be considered as an initial imaging modality in patients with concomitant signs and symptoms of DVT and contra-indications to VQ or CTPA.
    (2012) 30 EMDCNA 2 329-375