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Medical Malpractice Claims Involving Chest Pain in the ER

Chest pain is the second most common complaint of patients that present to the emergency room.  Sadly, most medical malpractice claims arise from the failure of the emergency room team to provide a proper and timely diagnosis of the life-threatening cause of the chest pain.

Some life threatening causes of chest pain include:  Acute Coronary Syndrome; Aortic Dissection; Pulmonary Embolism; Pneumothorax; Pericardial Tamponade; and Mediastinitis.  Non-life threatening sources of chest pain include:  Cardiac, pulmonary, gastrointestinal, musculoskeletal, and psychiatric causes.  

When a patient presents to the ER complaining of chest pain the first thing the ER physician should do is make a determination of whether or not the patient's chest pain is the result of a life-threatening condition.  The first step in determining the source of the patient's chest pain is for the physician to obtain a thorough history of the patient.  This is a crucial step and the physician should ask more than just what is on the pre-printed intake forms. Inquiry into the patient's history should include:  the onset of the pain (was it abrupt? or gradual?); provocation (which activities make it worse or better?); quality of the pain; radiation; site of pain; and timing (constant or episodic?).  Inquiry into prior diagnostic studies and illnesses should also be examined.  The timing of the onset of the chest pain can often help narrow the field of possible diagnoses.  Sudden and severe pain is often a sign of a life-threatening condition such as:  aortic dissection, pneumothorax, or Pulmonary Embolism.  Pain that begins gradually and worsens with exertion is often a sign of acute coronary syndrome.  

An important part of taking a detailed history of the patient should include inquiry into pertinent prior testing.  Many patients who complain of chest pain have had at least one prior episode.  The test results of the prior episode(s) may be useful to the ER physician in the current diagnosis.  If the physician failed to make this inquiry or failed to look into the findings of the prior tests that may be a basis for a malpractice claim.  

Some areas ripe for medical error include patients with Acute Coronary Syndrome (ACS) and Pulmonary Embolism (PE).  ACS is the most common life-threatening cause of chest pain.  Any patient that does not have a definitive diagnosis after having initial testing should be assumed to have ACS until proven otherwise.  PE is a life-threatening disease which is often missed by ER physicians because it manifests itself in a variety of ways and testing may result in nonspecific findings.  PE must be considered in any patient with acute chest pain or discomfort that does not have an alternative diagnosis.

Failure on the part of the physician in obtaining a proper and timely diagnosis in these types of cases can mean life or death.  A detailed patient history must be taken.  Prompt, thorough diagnostic testing and accurate review of the test results are crucial.  It is important to know what should, and should not, take place in the ER if you or a loved one feels that medical malpractice occurred.

Source:  "Chest Pain in the Emergency Room Setting:  Identifying and Managing Life-Threatening Causes", by Daniel Jeck, Esquire, Winkler Eisenberg & Jeck, P.C. 

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