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/BrobaFett]

PERC negative- already <2% pre-test probability

Wheezing- not a feature in most PE (~5-9% at most) and the pathogenesis of wheeze in PE is not clearly understood (very likely secondary to other concomitant causes of wheeze)

Diminished breath sounds- the most non-specific exam finding in the history of exam findings. I care about "diminished" breath sounds, as a pulmonologist, as much as a general surgeon cares about bowel auscultation

Got better with albuterol and steroids- PE doesn't get better with albuterol (steroids take longer)

ECG findings- Eh... maybe? Still, in a patient with so few symptoms that's an outpatient Echo in every shop I've worked at.

Died but we don't know why- OP, please.

Being 98% certain means you are still wrong 2% of the time. This is why you give return precautions. This is why you say things like, "It could be this, this or this but the tests aren't suggesting this". Let me put it this way, OP, unless there is something utterly incongruent with what you are reporting and what happened; I wouldn't hold this against you if it were my family member as the patient. We cannot expect perfection, especially when it's unreasonable to assert that perfection would have changed this patient's outcome.