Case Archive
Emergency Medicine
Ref. # 78148

A 39 year old Texas man was admitted to the ER, complaining of mid-chest burning, arm heaviness, vomiting and diaphoresis. No EKG was done; the patient was diagnosed with gastritis, treated with Maalox, and discharged. Four days later the patient suffered a massive MI and died. A medQuest ER specialist reported that the man's symptoms did require an EKG, which probably would have revealed pre-infarction angina, and he should have been immediately admitted to the hospital in any case.

Emergency Medicine
Ref. # 10348

A 22 year old Michigan man with prior family history (father and paternal grandfather) of aortic aneurysms developed acute onset of throat and chest pain. At an Urgent Care Center he was diagnosed with possible anxiety reaction; no chest X-ray was performed. He was admitted to a hospital ER the next day with the same symptoms, where he was diagnosed with muscular skeletal pain and given pain medication; no chest X-ray was performed. He died one month later at home. An autopsy revealed cystic medial degeneration of the aortic wall (congenital), dissection of ascending thoracic aorta with perforation, and massive cardiac tamponade. A medQuest emergency room specialist reported that in light of the patient's family history, the lack of chest X-rays at both health-care facilities was below standard of care, indicating potential liability for both.

Emergency Medicine
Ref. # 60828

An 18 year old Massachusetts woman presented to the ER complaining of a gas-like smell, shortness of breath, and left arm numbness. Her temperature was 101.6; white blood cell count was 14.3. She was diagnosed with gastroenteritis and anxiety, then discharged. That evening the woman had a seizure and was transported to a major hospital. The diagnosis was herpes encephalitis, which was treated with Acyclovir, and viral meningitis, which was treated with Dilantin and antibiotics. A medQuest ER specialist reported that during the initial ER visit the discharge instructions were below the standard of care. The noxious smell was ignored and no contact with the patient's primary care providers was attempted. The 36-hour delay in diagnosis ultimately caused long-term sequelae.

Emergency Medicine
Ref. # 38328

A 43 year old North Carolina veteran with a history of post-traumatic stress disorder, bipolar disorder, and diabetes presented to the ER with shortness of breath. A work-up, which included X-rays, showed a 100.2 temperature, tachypnia, respiratory rate of 40, and 84% oxygen saturation on room air. The diagnosis was pneumonia to be treated with Robitussin and Bactrim. The patient was discharged and advised to see his physician in one week. He was found dead 12 hours later in his home, where he lived alone. Cause of death was severe bilateral pneumonia. A medQuest ER specialist reported the X-rays showed severe bilateral pneumonia, which was negligently missed. Standard of care required admittance and treatment with IV antibiotics. The patient's death was preventable.

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