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/ihearttroponin ED Attending Jul 24 '25

"Someone said PE" so you don't even know that it was a PE for sure and you're guilting yourself? If the patient is truly Wells low risk, PERC negative, there was no reason to proceed with further PE testing. Sounds like it could have been asthma/COPD that maybe worsened after discharge

162

u/WobblyWidget ED Attending Jul 24 '25

there was a recent medmal review on perc/wells negative but ekg changes of RHS and the doc is appealing a 10mil decision for missing PE. this is why I threw out that . the jury doesn’t care. I’d rather have a negative ddimer at this point.

207

u/yurbanastripe ED Attending Jul 24 '25

My plan is to install a CTA chest scanner at the door that everyone entering has to walk through, kinda like a metal detector. Call it the PE detector

12

u/k3liix Jul 24 '25

As your friendly radiologist, please god no. We can’t take any more CT PEs.

9

u/MrPBH ED Attending Jul 25 '25

u/eFunkEM is singlehandedly ensuring that your children's' college (and medical school!) is going to be 100% paid for by the 4000% increase in CTA PA studies that will be ordered around the nation for the clinical indication of "TWI V1/III."

8

u/efunkEM Jul 25 '25

My evil plan is to scare everyone into ordering CTAs then sell an AI to read them all automatically. hides from angry radiology mob