r/emergencymedicine • u/Repulsive_Knee1304 • Jul 24 '25
Advice Missed PE, patient died
Throwaway account as to be expected.
I had a younger obese smoker male patient come in recently for shortness of breath that was exertional in nature, he said it started after he recently started working out. Patient was a smoker, 1/2 pack a day. SOB Resolved upon rest. patient states that he was carrying some heavy containers at work today, and noticed the shortness of breath again. No chest pain. No diaphoreses . No fever. No lower extremity swelling. No recent uri. Perc negative. Low pretest probability. Physical exam was significant for an expiratory wheeze, diminished sounds at bases. Patient got Breathing treatments, steroids and felt better. Reexamination showed improved aerations. Patient was discharged on steroids, albuterol. EKG NSR rate of 74, t wave inversions in v1-v3. No inversion in lead 3. No st changes. Cxr portable showed poor inspiratory effort, cardiomegaly( rotational?) but read as normal by radiologist and myself. Completely stable vitals. O2 sat of 95%, no tachy. No chest pain. Sob got better. Perc negative. Patient died at home 2 days later. Someone said PE. My guilt is consuming me. How fucked am i
EKG- S1,small q3. No t wave inversions in III. So no t3. Sinus rythym rate of 74 Qrs 88. Upright axis V1-v3 t wave inversions. No previous to compare to
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u/Throwawayyawaworth9 Jul 24 '25
I’m sorry you’re feeling so much guilt over this— it’s a very hard emotion to work through.
This patient does not read as a PE— I suspect this would have been very difficult to catch.
You did an appropriate workup. You did the best you could. Sometimes things will be missed. We are human after all.
However, I doubt that anything we could say here can completely alleviate your negative thoughts. Do you have a therapist or anything you can talk this through with to help cope with your feelings of guilt?