I have a question about PE and DVT, can anyone help?

  1. Hopefully someone will read this that can help me. Here's the scenario.... 59 year old woman with history of ulcerative colitis. Leg pain in right leg for over a month, turns out to be a DVT, admitted to hospital and put on Coumadin. The Coumdin had to be DCd because of the ulcerative colitis. She was losing too much blood. Shortly after Greenfield filter was placed. A couple of weeks later she experienced dizziness so she went to the ER. She was admitted for observation, chest Xray was done. Blood pressure dropped quickly so she was moved to ICU where she noticed that her right leg (not the one with the previous DVT) was wine colored all the way to the groin area. She experienced sever pain in this leg. Physician was called in (he took 2 hrs to get there), he told the woman that Xrays showed she had a PE and he wanted another physician to see her in the morning (this was around 9 pm). The next day around noon both legs were wine colored up to the groin, pupils were dilated and did not react to light. BP was 53/47. Mediflight was ordered to take her to a larger better equipped hospital but the physician changed his mind and said she was not critical, he decided to send her by ambulance which would take at least 4 hours (ambulance was enroute somewhere else, so she would have to wait). I advised womans spouse that he should request to pay for mediflight because his wife was seriously ill. So he did, mediflight was there within 30 minutes, however they had to land half way to hospital to entubate her. She was responsive but confused when mediflight picked her up. When she arrived at the larger hospital she was totally out of it. She died 2 days later, after gaining over 70 pounds due to all of the fluids and blood she had been given to keep her blood pressure up. She had clots throughout her body. Physician there said she had "probably been throwing clots all night long". Cause of death was listed as acute renal failure, hypovolemic shock, and deep vein thrombosis. Am I crazy or could this have been prevented??? I'm just a student nurse so I know I have much to learn, but if I knew she was critical why didn't everyone else? Super Nurse if you're out there please answer my question.
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  2. 5 Comments

  3. by   NRSKarenRN
    congratualtions, you've used critical nursing skills!!!
    59 year old woman with history of ulcerative colitis. leg pain in right leg for over a month..... physician was called in (he took 2 hrs to get there), he told the woman that xrays showed she had a pe and he wanted another physician to see her in the morning (this was around 9 pm). the next day around noon both legs were wine colored up to the groin, pupils were dilated and did not react to light. bp was 53/47. mediflight was ordered to take her to a larger better equipped hospital but the physician changed his mind and said she was not critical,
    since she had leg pain for a month, probably had multiple clots developed over that time. seeking treatment sooner may have saved her life.

    by insiitng on medflight with bp 53/47, can you imagine what would have happend to spouse when she stopped breathing 1/2 way to hospital???
    you gave her chance at extended life...kudos to you.

    put that doc on your be warry list....sometimes they can't see the forrest for the trees.

    be glad to work with you anyday.


    just posted this info yesterday, has pictures and info
    re: can someone please explain inr & coumadin therapy to me?
  4. by   kimmie518
    Just curious, was she on a diuretic or have a foley catheter in?
  5. by   nurse charlie
    She had a foley and was given a one time dose of 40 mg of Lasix. In a 12 hour shift she had over 4300 in and only 114 out. Thanks for your replies!! I really just want to know how to handle this kind of situation after I graduate (May 07!! Wooo Hooo!!). What do you do when you feel like a physician is just sitting around and watching someone die?
  6. by   NRSKarenRN
    Quote from nurse charlie
    What do you do when you feel like a physician is just sitting around and watching someone die?
    Report up the chain of command: Charge nurse, nursing supervisor, unit medical director or hospital medical director.
  7. by   CritterLover
    Quote from nurse charlie
    hopefully someone will read this that can help me. here's the scenario.... 59 year old woman with history of ulcerative colitis. leg pain in right leg for over a month, turns out to be a dvt, admitted to hospital and put on coumadin. the coumdin had to be dcd because of the ulcerative colitis. she was losing too much blood. shortly after greenfield filter was placed. a couple of weeks later she experienced dizziness so she went to the er. she was admitted for observation, chest xray was done. blood pressure dropped quickly so she was moved to icu where she noticed that her right leg (not the one with the previous dvt) was wine colored all the way to the groin area. she experienced sever pain in this leg. physician was called in (he took 2 hrs to get there), he told the woman that xrays showed she had a pe and he wanted another physician to see her in the morning (this was around 9 pm). the next day around noon both legs were wine colored up to the groin, pupils were dilated and did not react to light. bp was 53/47. mediflight was ordered to take her to a larger better equipped hospital but the physician changed his mind and said she was not critical, he decided to send her by ambulance which would take at least 4 hours (ambulance was enroute somewhere else, so she would have to wait). i advised womans spouse that he should request to pay for mediflight because his wife was seriously ill. so he did, mediflight was there within 30 minutes, however they had to land half way to hospital to entubate her. she was responsive but confused when mediflight picked her up. when she arrived at the larger hospital she was totally out of it. she died 2 days later, after gaining over 70 pounds due to all of the fluids and blood she had been given to keep her blood pressure up. she had clots throughout her body. physician there said she had "probably been throwing clots all night long". cause of death was listed as acute renal failure, hypovolemic shock, and deep vein thrombosis. am i crazy or could this have been prevented??? i'm just a student nurse so i know i have much to learn, but if i knew she was critical why didn't everyone else? super nurse if you're out there please answer my question.

    since she already had one clot, she was at very high risk for developing another clot. since she was unable to tolerate anticoags to prevent just such a thing from happening, she most likely did develop more clots. not only to her other leg, but probably other places, too. these clots could have formed in/near her vital organs -- heart, lungs, kidneys, brain; or they could have formed elsewhere and broken off and gone to these organs

    a greenfield filter only helps with clots that deveolp below it -- it doesn't help at all if the clot is above where the filter is placed (usually inferior vena cava, somewhere around your navel).

    not only can the clots cause organ damage, but they can also initiate a sirs cascade, which is what sounds like happened.

    it really doesn't sound as though much could have been done. and while i most definitly agree with the decision t fly her to a higher level of care, part of me wonders if the doctor didn't think there wasn't much that would be gained?

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