Find out what doctors do when patient is struggling to breathe and has chest pain soon after knee or other joint replacement surgery.

Sudden difficulty breathing, especially if combined with chest pain, soon after joint replacement surgery is a strong tell-tale sign of a pulmonary embolism, says information on the mayoclinic.com site (links at conclusion of this article).

My father just had knee revision surgery because the surgeon suspected that the source of ongoing, disabling pain was because his total knee replacement had become loose.

Naturally, I was very concerned about the issue of pulmonary embolism, a blood clot in the lung that develops initially as a blood clot in a deep vein, usually in the lower leg (deep vein thrombosis).

I visited my father in his room three hours after surgery. On both feet were sequential compression devices that periodically inflate to squeeze against the patient’s feet to generate circulation in the legs.

He was also on the blood thinner Coumadin, and was wearing knee high compression stockings.

If one of these protectors against deep vein thrombosis is missing when you visit a patient who’s just had joint replacement surgery (namely knee and hip), you should be alarmed.

Some doctors use aspirin instead of the Coumadin, which is equally and seems to be even more effective, reports researchers from the Rothman Institute at Jefferson.

A deep vein thrombosis can dislodge and travel into the lungs and “embolize,” creating a life-threatening situation.

A doctor (not the surgeon) came into my father’s room to give him a routine post-surgical checkup. Everything was perfect.

After that, in the corridor, I asked the doctor, “If a patient suddenly has trouble breathing and chest pain, what is the protocol as far as addressing that?

“What if he can’t yell out for the nurse, and presses the call button but the nurse is very busy and doesn’t get there till 10 minutes later? Meanwhile he has a pulmonary embolus and can’t breathe.”

The doctor said that the nurse would be there quickly. She also said that when it’s strongly suspected that a patient has a pulmonary embolus (trouble breathing, chest pain, just had joint replacement surgery), the diagnosis must be confirmed FIRST (CAT scan) before clot-busting drugs (thrombolytics) are administered via I.V.

“Thrombolytics can kill a patient,” she told me. This risk cannot be taken when a pulmonary embolus has not been confirmed.

Once it’s confirmed, nurses set up the I.V. and infuse the clot-busting drug throughout the body. They cannot do this without a doctor’s authorization.

There wasn’t time for me to ask the doctor what happens if, on the way to the CAT scan, the patient takes a turn for the worse and is starting to turn blue. There’d be no time to get the CT image!

However, the doctor did point out that with joint replacement surgery in a healthy person, the odds of a major pulmonary embolism are small.

The highly lethal “saddle” pulmonary embolus is more likely to occur in someone with a pre-existing clotting disorder.

The type of pulmonary embolus that usually develops in joint replacement patients are smaller clots that occupy one lobe of the lungs (a pair of lungs has five lobes total).

The doctor explained that a patient could have trouble breathing because a clot is in one lobe, but still be able to breathe with the four other lobes and have plenty of time for clot-busting treatment.

If you’re visiting a patient who just had surgery (particularly joint), and they suddenly “can’t breathe” and have chest pain, or even one of thee symptoms, don’t waste a second; get help.

Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  

 

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Top image: Shutterstock/ESB Professional
Sources:
mayoclinic.org/diseases-conditions/pulmonary-embolism/basics/symptoms/con-20022849
mayoclinic.com/health/pulmonary-embolism/DS00429/DSECTION=risk-factors