David Bloom, Pulmonary Embolism, Cause?

[Premed2003]

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As many have heard, David Bloom died of a pulmonary embolism in Iraq. Was this caused by all of the bouncing on the army car he was on, and the sand he breathe in? If he had symptoms, he probably thought they were from the dust? I'm not familiar with pumonary embolisms - just curious🙁

 

[md_student10021]

Based on what little information has been released, I assume he suffered DVT secondary to the long flight to the gulf. PE followed, and without adequate medical attention, a terribly unfortunate outcome resulted.

 

[Premed2003]

What is DVT? Do a lot of people get it after a long flight and have symptoms? David Bloom had those symptoms but attribute it to the stress of being in Iraq? Or are there no symptoms?

Sad 🙁 🙁 🙁

 

[DW]

Originally posted by md_student10021
, I assume he suffered DVT secondary to the long flight to the gulf.

so, for those of us who havent started medical school yet, anyone wanna translate? 😉

 

[Brewster]

I apologize in advance if I dumb this down too much, but you said you don't know anything about it...

Embolism is the migration of a clot. Pumonary embolism is the migration of a clot to the arteries of the lungs. In the case of pulmonary embolism, the clot typically originates in the large veins in the legs. The clot then breaks off, travels through the veins to the right side of the heart and is then pumped into the pulmonary arteries. As you might imagine, having a clot in the pulmonary arteries can have a couple of consequences:
1) It interferes with the oxidation of blood (since the pulmonary arteries are carrying blood to the lungs so that it can pick up oxygen and get rid of carbon dioxide).
2) If the clot is big enough, it can block the pulmonary artery completely, leading to acute heart failure.

Major risk factors for clots in the legs are immobility (patients in hospital beds, people on long plane rides), a disorder of clotting that causes you to clot too much, cancer, and others.

So, it may be related to being in the plane/jeep for a long time. Pulmonary embolism is not associated with inhaling dust.

A DVT is a deep venous thrombosis (the leg clot I referred to above). A thrombus is a clot that has not migrated (as opposed to embolus above). And, of course, since it is in the deep veins (of the legs) it is a deep venous thrombosis.

 

[Premed2003]

Thanks for your info

FYI, on MSNBC, they're having a doc come on to talk about pulmonary embolism shortly. 🙁

 

[SolidGold]

According to Tom Brokaw, Bloom was complaining of leg cramps and pain a few days before he collapsed and died, so the clot might have originated in his lower extremities.

 

[Brewster]

That would be consistent with DVT. Signs/symptoms suggestive of a clot in the lower extrimities are pain, tenderness in the calf, and swelling (particularly if it is of one leg only).

 

[doepug]

Brewster's discussion of PEs is right on.

Sounds like Mr Bloom may have had a DVT, but it's unusual for otherwise healthy young guys to have them. Yes, it was a long plane ride to Iraq, but that's not a likely answer in this case, especially since he's been there for a while.

In an otherwise healthy young man, a coagulopathy is probably to blame. Genetic deficiency or errors in any of several blood elements can cause clots to form. As many as 3% of Caucasians have a mutation in a clotting factor, called Factor V Leiden; this is responsible for a great many PEs in young patients.

It should also be noted that the overwhelming majority of PEs, while serious, are not fatal. Mr Bloom must have had a massive PE (ever heard of a saddle embolus?), since he died so quickly. All of you will undoubtedly care for patients with PEs while you're medical students.

Cheers,
doepug (MS III)

 

[almostMD]

yeah, it is possible that Bloom had a DVT that led to a massive saddle embolus. From what I understand, he was embedded in a unit on the front lines. I don't know if his daily routine included long periods of sitting in a tank or whatnot, so DVT cannot be ruled out. But we also need to consider some other causes. Perhaps he had one of a number of coagulopathies (Factor V Leiden where factor V cannot be inactivated by protein C, Proteins C and S deficiencies, hyperhomocysteinemia, etc.). Or perhaps he had paroxysmal atrial fibrillation without a rapid ventricular response (his atria were fluttering like jello - blood pools and clots form). He could have been shooting emboli everywhere. He might have had primary thrombocythemia (too many platelets).

We'll know soon enough. It's a tragedy nonetheless.

 

[lizzied2003]

when i saw film of the soldiers crawling out of the back of those cramped tanks i never really thought about the possibility of DVT. I would render a guess that it doesn't occur that frequently in soldiers because they are going in and out the tanks. I wonder if he would have survived if he was stateside and could get quick access to care or if it would have even happened here.
While Bloom seemed to be quite mobile you have to wonder if he had long periods of immobility and given the c/o calf pain i'd go with the previous poster with the DVT thing. Food for thought; we've never had this much coverage of any war...should people who are going to be cramped up and not move alot get DVT prophylaxis?

 

[Woots32]

This taken from MSNBC.com...

Bloom, who had no apparent health problems, was indefatigable during the war. He reported at all hours for NBC News broadcasts, and also for the cable outlets MSNBC and CNBC.
?Given the fact that we?re filing at all hours of the day and night, you try to pace yourself and get a little sleep,? Bloom told the Post. ?You?re sleeping with your knees propped up around you.?
That may have been a risk factor: blood clots frequently form in legs when they?ve been immobilized and travel through the body, said Dr. Harold Palevsky, chief of pulmonary critical care with the University of Pennsylvania health system.
Dehydration can also be a factor. Palevsky said Army medics, trained and equipped to stop bleeding, may have been less prepared in the desert for a pulmonary embolism.

 

[Dr. Lawyer]

Doepug, DVT - PE is not as uncommon as you might think in healthy young people. Numerous case reports demonstrate that plane flight induced DVTs can cause fatal PE even several weeks after the flight.

All arguments aside, here are some helpful pointers. Hydrate and take an asprin before long plane flights and get up to walk around every 90 minutes. This, coming from eminient lung docs. Also, if you're a reporter, leave the riding in tanks to soldiers.