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/Patient-Rope-4053 Jul 27 '25
This happen to my daughter . All new nurses on the flour & no crash cart . I had to orient her while I was working & told her to find another job . I told her the next time how to make sure a crash cart is on that floor start of shift & get order for BNP next time if patient is complaining of those symptoms what cardiac labs and tests she needed & include a BNP . Happened her next shift , patient was saved went to ICU . She said they wanted to “ how did you know to order BNP “. She didn’t tell them . She did resign & found a hospital that gave her 8 weeks of orientation, they were glad to have her . This was during the time we switch from paper charting . She also had a computer technology degree , they hired her in with a nice hourly wage .