Patients can present to the emergency department with any diagnosis, but as emergency physicians we are focused on a finite subset of conditions that require emergent diagnosis and treatment. There are many complex diagnoses we can’t make with the tests at our disposal (internal medicine diagnoses like celiac, Wegener’s, etc), and there are many benign…
There are patterns diagnoses for patients discharged from the Emergency Department whose were deemed well enough for discharge and whose diagnoses were missed (MI dismissed as GERD, fracture missed on Xray, appy misdiagnosed as gastro). But there are other patterns of diagnoses for patients who are deemed sick enough to require hospitalization, but the reason…
What can we learn from medico-legal cases about the most common errors in the Emergency Department? Two studies of closed malpractice claims from adult patients highlight the importance of misdiagnosis, especially for MI, fraction, infection and appy: An Epidemiologic Study of Closed Emergency Department Malpractice Claims in a National Database of Physician Malpractice Insurers. Acad…
Subarachnoid hemorrhage is a classic emergency medicine diagnosis: rare, deadly, and easiest to miss in its early stages when there’s the greatest chance of intervention. A third of SAH die immediately, a third have longterm neurological consquences, and a third make a good recovery–and it’s this last group that has the highest miss rate and…
Cocaine intoxication provides a hypertensive crisis, sodium channel blockade, a dose of serotonin, inflammation from the debris, and potential acute and chronic injury from the portal of entry. So we need a systematic method to consider complications while stabilizing the patient. A: Apply C-spine and Assess airway C-spine injury from fall aspiration risk B: CHEST…
Pulmonary embolism is both over-investigated in young people and missed in elderly people and those with comorbid conditions, and those with PE can have a benign or complicated course. I’ve shared some bounceback cases on PE, and here are a few studies to keep in mind to better assess and manage patients with potential PE…
Posterior circulation strokes are less common and have a wide spectrum of symptoms and signs, so it’s not surprising they are easily missed. Here are a few misses/near misses, and their associated misdiaganoses ‘GASTRO’ 60yoM with a history of DM/HTN presents with dizzy/vomiting all day, one diarrhea. No documented neuro exam, given fluids and…
If a patient presents with pleuritic chest pain, shortness of breath and a clear chest on auscultation and xray, we obviously think of pulmonary embolism. But PEs are missed 10-30% on their initial presentations, so we should be aware of the atypical presentations. Here are a few misses/near misses based on the misdiagnosis ‘REACTIVE…
Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine. Emerg Med J 2016;33:245-252 This new study shows the potential of voluntary reports to help identify and learn from errors. First, the study itself was part of a broader culture of safety that every emergency department could adapt to identify and learn…
Emergency Medicine: A practice prone to error? CJEM 2001 Oct;3(4): 271-276. This classic article by Drs. Croskerry and Sinclair, pioneers in the study of emergency medicine error, is just as relevant now as it was when it was written 15 years ago. Some excerpts: On the unknown scale of the problem of errors: “The first…
