Missed PE, patient died

[u/Repulsive_Knee1304]

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

[u/No-Football-8824]

I've been reading medmal cases and yes I read the one about the negative perc (not documented in the chart though) and the family died and won 10 million. Now imagine you only have malpractice for 1 mil. Technically they can go after your personal assets.

We absolutely need tort reform because it's pretty obscure and we use the clinical rules we were given and still can be wrong.

Sadly it seems like best practice is to CTA a hell of a lot more SOB patients. One could even argue a negative d dimer wouldn't protect you in a lawsuit. Sadly it just means more radiation.

A lot harder to prove that you caused their cancer 20 years down the road when they got scanned 10 times than it is if you miss that one PE because you didn't scan when you could have.

I wish you the best and hope this doesn't result in a lawsuit. Sometimes that just depends on the family and if they have the economic support to continue to pursue a case with lawyers and whatnot.

Hopefully it doesn't end in a lawsuit but if it does settle within your limits imo at all costs. Nothing worse than them going after personal assets.