Post by Sharon TooPost by HunterIt is funny how many deadly illnesses have "flu like" symptoms. It is
like the diseases want to sneak up on us. I know, it is the body
trying to fight off infection and fever is often the way to do it. It
just sucks that you are there belatedly drinking down orange juice
and Robitussin while you have the Plague or something LOL!
Doc Sharon would be better to answer this question. Our patients have 4
legs.
But - flu-like symptoms are fever and general malaise, not vomitting.
http://www.newyorkpersonalinjuryattorneyblog.com/2008/02/medical-malpractice-trial-of-john.html
[T]he cardiologist [was] summoned to the emergency room at Providence St.
Joseph Medical Center in Burbank after Ritter was taken there complaining
of nausea, vomiting and chest pain. Plaintiff's lawyers say a chest X-ray
should have been performed before Lee treated Ritter.
The doctor's lawyers say that there wasn't enough time for that and that
a chest X-ray ordered earlier inexplicably was not done. They say Ritter's
symptoms were more consistent with a heart attack than anything else and
had to be treated quickly."
I would think that anyone who comes into an ER (especially a middle aged
male) with nausea *and* chest pain would at least be ruled out for
something having to do with the aorta. Take the damn x-ray, do a quick
sonogram while also assuming a heart attack. According to this article, an
earlier x-ray was taken and an enlargment of the aorta was missed. I hope
this wasn't a managed medicine snafu where they were holding back on
diagnosics to appease the HMO because of whatever they define as "routine
care".
But I suppose this could be a 'zebra'.
It was indeed a zebra. Aortic dissections are really pretty rare, much less
common than heart attacks. They also tend to occur in elderly men, not
middle aged ones, except in cases of trauma or Marfan's syndrome (remember
the eppy that lead to Malucci's firing and Chen's losing the Chief Resident
position). Calcifications of the aorta on an Xray are an indication of
atherosclerotic disease, but that doesn't occur in isolation; a man like
Ritter who had aortic disease undoubtedly also had coronary artery disease.
Therefore, even knowing he had aortic calcifications, a heart attack was
still a good possibility. Chest pain and nausea are common in MI. There
can be EKG changes seen in aortic dissection that would mimic MI, too. It's
a tough diagnosis until the aorta ruptures entirely, at which time it is
often too late.
The big issue here is the chest film that didn't get done, as it might've
well showed suspicious widening of the aorta as blood flowed into the
dissection prior to the dissection rupturing into his chest. I think this
is why the hospital settled the case, aside from wanting to avoid the bad
PR.
I seriously doubt this was an HMO issue. The guy was a famous actor, a
multimillionaire. Even if he had an HMO, nobody would've hesitated to order
every test in the book, especially in LA where giving VIP treatment to the
famous is routine. A chest film on someone with chest pain is absolutely
routine and a relatively cheap test. Many folks with pneumonia present to
the ER with chest pain and nausea.
Although the plaintiff's attorneys claimed that the radiologist who had read
a previous chest film on Ritter had missed widening of the aorta, the
defense denied that and produced witnesses who said that the film did not
show significant changes. The jury believed the defense experts. Most
things in medicine are more art than science and it is quite possible for
good practitioners to disagree on the significance of various findings.
Sharon