Pulmonary embolism occurring early after major trauma

Abstract

Pulmonary embolism (PE) secondary to trauma is the third most common cause of death in trauma patients who have survived 24 hours following injury. We describe a case of PE diagnosed within 3 hours of a major trauma in a previously well adolescent female. The early occurrence of PE in this case is at odds with what is generally reported (3–5 days) after major trauma. General consensus is that patients who suffer major trauma move from an initial hypocoaguable state, with increased risk of bleeding, to normocoagulable or hypercoaguable state, with a subsequent increased risk of venothromboembolism. However, Sumislawski et al recently demonstrated that a marginally greater proportion of trauma patients were in fact hypercoaguable rather than hypocoaguable on arrival to hospital and that trauma-induced coagulopathy tended to resolve within 24 hours; such data cause us to re-evaluate when to commence thromboprophylaxis for major trauma patients.

Understanding Preventable Deaths in the Geriatric Trauma Population: Analysis of 3,452,339 Patients From the Center of Medicare and Medicaid Services Database

“…The occurrence of perioperative PE/DVT in the geriatric population is multifaceted and is likely due to the increased prevalence of immobility/poor baseline functional status of this cohort in combination with inherent hypercoagulability associated with major trauma as a result of massive cytokine release and inflammatory responses. 32,33 However, it is interesting to note that central venous catheters have been associated with an increased incidence of thrombosis in geriatric patients, with a history of clotting disorders, high-lumen, and large-gauge catheters serving as risk factors for PE/DVT. 34,35 In combination with our findings that central venous catheter-related infections produced the highest preventable O/E ratios overall, this may indicate that the use of central venous catheterization in the geriatric population is a large contributor to geriatric patient mortality by increasing the risk of infection in addition to thrombosis/embolism and could benefit from interventions which minimize the use of central venous in the geriatric trauma population.…”