Failure to diagnose is the most common medical error in the practice of emergency, urgent care and primary care medicine. Spinal epidural abscess (SEA) is one of the most difficult conditions to diagnose, but there are common threads among failure to diagnose spinal epidural abscess cases. This case is presented to provide perspective and to increase our vigilance for catching this disabling and possibly even fatal diagnosis.
The uncommon but lethal infection known as necrotizing fasciitis continues to be in the news. This is a devastating disease that can be difficult to diagnose in the early stages. The first presentation is often nothing more than arm or leg pain that looks very much like garden-variety musculoskeletal discomfort. By the time the diagnosis is made, the disease process is often too far along to reverse it, resulting in severe disability or death. However, there are usually a few clinical clues that a more dangerous process is under way.
The temperatures are rising, and school sports are starting long practices in all kinds of weather. During intense exercise, people can lose up to 1.5 liters of fluid per hour. Summer is prime time for pediatric patients to sustain heat-related illnesses, and these patients may present to the emergency department in some distress.
The majority of animal and insect bites and stings are harmless and can be managed at home. However, there are many that can cause a medical concern, some more acute than others. Read these 10 secrets to brush up on your approach to the patient who presents with a bite or sting this summer.
Only the common cold prompts more people to see a practitioner than acute low back pain. Most people will suffer with low back pain at least once in their lives, and it is estimated that 2% to 3% of all ED visits are for acute non-traumatic back pain. With costs exceeding $90 billion per year, the far-reaching implications are clear. Acute low back pain affects men and women of all ages; it is a common cause of disability in those less than 45 years of age due to work-related injury. Patients experience pain and lost wages; employers are impacted by loss of productivity in the workplace; and there is a major financial burden to society in general.
Pinched, pushed, punched, or even stabbed, shot or killed. Nearly every healthcare worker has been a victim or knows a coworker who has been a victim of workplace violence.
Workplace violence represents a serious health and safety concern for all employees, but healthcare workers in particular face significant risk. Health and social service industries account for 48% of all non-fatal injuries from occupational assaults and violent acts.
A 35-year-old female presents at 0321 by ambulance with a complaint of chest pain. The records show EMS arriving at her house and finding the patient on the couch.
EMT Notes
Patient appears to be anxious and hyperventilating.
[3 MIN READ]
Arriving at the correct diagnosis sometimes follows a short and simple journey.
Consider the classic case of shingles, for example, where the one-step process consists of recognizing the tell-tale pattern of vesicular lesions. Contrast the rash of shingles with the more elusive symptoms of chest pain, headache, or weakness, which usually require a multi-step approach to reach the correct conclusion.
As clinicians, we were all taught the “diagnostic process” in some shape or form. What we didn’t always learn is that each step in the process is accompanied by potential missteps that can take us down the path to misdiagnosis.
A 78-year-old man, Mr. S, came to the emergency department with the chief complaint of abdominal pain. He was an active person, residing in the independent living section of a retirement complex. He described the pain as an ache in the mid and lower abdomen that had been present for several days. The pain did not radiate. He denied any fever, nausea, vomiting or diarrhea. He claimed having no appetite or bowel movement “for days.”
There is a new risk and safety issue in the world of appendicitis. In this issue of TSG Quarterly, we explore the issue of conservative, antibiotic-first management of acute appendicitis with appendectomy reserved for treatment failures. Is it the new standard? Have you proactively addressed this issue with your emergency medicine and surgical practitioners? It is important to get out in front of this issue to keep our patients safe!
