David Bloom was a reporter on MSNBC, and I truly enjoyed his work. He died suddenly in Iraq, of non-traumatic causes, and the current speculation (and that’s what it is, we have no proof as of yet) is that he died of a massive PE (pulmonary embolism). PE’s are usually blood clots, but can be air bubbles (diving) or fat bubbles (orthopedic surgery).
What this is going to do is again sensitize the public to the issue (which was covered extensively last year in article about ‘tourist class’ syndrome on long plane flights), and they’re going to start showing up in doctor’s offices and ED’s. Those that go to the doc’s office will most likely be referred to the ED, as we can get the workup done very quickly, so we’ll see the majority of them.
Which brings me to my rant. We (docs, specifically ED docs) have been told for the last several years that there was an epidemic of undiagnosed PE’s out there we were missing, and thereby doing harm. We, therefore, started testing scads of patients with even minimal symptoms for PE’s, and you know what? I have been surprised by an unexpected positive exactly once. Patients are either classically symptomatic or they aren’t; the classic ones need only a confirmatory test, the non-classic get the big and usually fruitless workup. I’m still testing as I did before as I don’t want to miss this diagnosis, but the ‘epidemic’ is overblown.
So, I’m getting ready for a wave of PE visits. I’ll let you know how it goes where I am.
Now the question is, CT Angio, VQ, PA Gram. How far do you go if one test is negative. D-Dimer? I have had no luck with D-Dimer, contrary to PIOPED Study. If all is negative, do you doppler the extremities? How many overweight, BCP taking and/or smokers do you see a day with vague complaints? All you have to do is miss one PE and you become a liberal, run-up-the bill so the lawyers can’t get cha kinda doc.