Are You Safe in the ICU? 5 Missed Diagnoses and How to Protect Yourself
Posted on behalf of Janet, Jenner & Suggs on Aug 01, 2013 in Medical Malpractice
As a medical malpractice attorney, it never ceases to amaze me how many patients suffer injuries or even die due to missed diagnoses. If you think the gravely ill patients in an intensive care unit are shielded from these medical errors, think again. A study by Bradford Winters, an associate professor of anesthesiology and critical care medicine, found diagnostic errors are common in intensive care units. According to his research, more than twenty five percent of patients who died in an ICU had at least one missed diagnosis! He estimates as many as 40,500 ICU adult patients die each year with an unknown medical condition.
What’s to blame for these potential deadly errors? A combination of factors including fatigue, information overload, and time constraints contribute to missed diagnoses. The medical errors found in the intensive care unit also plague emergency rooms and hospitals across the country. Clearly, we need an overhaul of our approach to patient care in this country. In the meantime, there are steps you can take to protect yourself and your loved ones. A recent article from the AARP outlined the 5 most frequently missed diagnoses in the ICU.
1. Heart attack
Death of — or damage to — part of the heart muscle, usually after a blood clot reduces or stops blood flow.
Symptoms: Classic symptoms include chest pain, shortness of breath, dizziness or light-headedness and breaking out in a cold sweat. Less common symptoms include nausea, vomiting, overwhelming fatigue and pain in the jaw, back, neck or shoulder blades. Women are more likely than men to have these less common symptoms, but men can experience them as well.
Confused with: Doctors may diagnose a heart attack as heartburn, a gallbladder infection or pulmonary embolism. In some cases, symptoms are mild enough that neither doctor nor patient realizes that the patient’s symptoms are significant.
Diagnostic tests: Blood tests for heart muscle enzymes (cardiac specific troponin I or troponin T) can reveal whether the heart muscle has been damaged. Generally, the more damage to the heart, the greater the amount of troponin T in the blood. Although patients in the ICU are often connected to heart monitors, a special diagnostic electrocardiogram (EKG) is often required to detect a heart attack.
Treatment: Medications include aspirin and beta-blockers. Doctors also may perform an angioplasty procedure to open blocked arteries. Stents may be placed inside the artery to help keep it open.
2. Pulmonary embolism
A sudden blockage in a lung artery
Symptoms: Patients usually have shortness of breath, chest pain and a cough.
Confused with: Symptoms can mimic those of an asthma attack, pneumonia, bronchitis or even a heart attack.
Diagnostic tests: If doctors suspect a pulmonary embolism, they can order a CT scan of the lungs. Nearly all patients with a pulmonary embolism have deep vein thrombosis, a formation of blood clots in the leg, thigh or pelvis. When patients have this condition, physicians should take precautions against the clot moving to the lungs.
Treatment: Clot-busting and blood-thinning medications are typically administered, as is supplemental oxygen if blood oxygen levels are low. In rare cases, surgery is required to remove the clot.
Inflammation of the lungs because of infection
Symptoms: People usually experience coughing, fever and chills. They may also have difficulty breathing.
Confused with: The lung infection can also be confused with asthma or even tuberculosis. Also, because different forms of pneumonia require different treatments, mixing them up can waste precious time.
Diagnostic tests: A chest x-ray is typically used to confirm a pneumonia diagnosis. A CT scan also can detect pneumonia. Doctors can listen for a rattle in the lungs or do a pulse oximetry test to gauge how much oxygen is in the blood. A sputum test can reveal the cause of the infection and the severity of the illness.
Treatment: If the infection is bacterial, antibiotics generally will help clear it. If it’s a viral pneumonia, antiviral medications are administered in some cases. Supplemental oxygen is given when blood oxygen levels are low.
An infection or allergic reaction caused by the aspergillus fungus, which commonly grows on dead leaves.
Symptoms: Typical symptoms include coughing, fever, chills, chest pain, shortness of breath and headache. The fungus is common in the environment but generally only causes problems in people who have weakened immune systems.
Confused with: Aspergillosis can look like asthma, tuberculosis or acute respiratory distress (which can develop after a trauma or a drug overdose, among other causes). It also can mimic a bacterial or viral pneumonia.
Diagnostic tests: A chest x-ray or CT scan can show a fungal mass in the lungs. A sputum test can confirm that the aspergillus fungus is to blame. Skin and blood tests can reveal whether an allergic response is at the root of the illness.
5. Abdominal bleeding
Bleeding that starts in the stomach, esophagus, small bowel or colon.
Symptoms: An unexplained drop in blood pressure and rise in heart rate can signal internal bleeding, as can weakness, light-headedness and shortness of breath. Symptoms can include vomiting and bloody or dark, tarry stools. Blood spilling into the lining of the abdominal cavity can cause pain, and the stomach will feel rigid.
Confused with: Internal bleeding is notoriously hard to diagnose in the ICU because many patients are already weak and light-headed, and blood pressure and heart rate fluctuations are symptoms of a number of conditions.
Diagnostic tests: Blood tests may show a low red blood cell count or anemia. A stool sample can also detect the bleeding. Endoscopy, angiography and CT and nuclear medicine scans can all help doctors pinpoint the source of the bleeding. If the patient already has a stomach tube in place, medical staff can take a sample of fluids in the stomach.
Treatment: Doctors may put a clip on a bleeding blood vessel or use heat, electric current or laser to stop the bleeding. Surgery is sometimes necessary.
What to Do if You’ve Been Misdiagnosed
In order to help prevent a missed diagnosis, do your part to help the doctors understand your medical history and the events that led to your hospitalization. The more background you can provide, the more likely it is that your medical team will be able to rule out inappropriate diagnoses. Pay attention to your gut instincts. If you believe your medical providers aren’t paying close attention to your needs or if something just doesn’t feel right, seek another opinion.
If you or a loved one has suffered from a missed diagnosis, you may want to seek the legal advice of a qualified medical malpractice attorney. Contact our firm to find out if you may be entitled to compensation for your injuries.