ED Legal Letter – March 1, 2019
March 1, 2019
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Missed STEMI Suit Could Succeed if Plaintiff’s Expert Sees No ECG, Troponins, or Cardiology Consult
When a plaintiff attorney’s expert reviews the ED medical records on a potential missed ST-elevation myocardial infarction (STEMI) case, certain “smoking guns” immediately become apparent.
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Despite Excessive Testing for Low-Risk Chest Pain, EDs Still Miss Some Myocardial Infarctions
There are some fresh recommendations for EDs treating patients with suspected non-ST-elevation acute coronary syndromes. A new clinical policy from the American College of Emergency Physicians addresses the evaluation and management of these patients.
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HEART Score Mitigates Risk — But With ‘Important Shortcomings’
The authors of a recent review deemed the HEART score an excellent predictor of major adverse cardiac events in adult ED patients with chest pain. Experts debate the score's merits while comparing it to other prediction and diagnostic tools.
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Atypical Symptoms, Atypical Patients: Both Increase the Odds of Missed STEMI
The “typical” heart attack patient presents with midline chest pain, sweating, and nausea. Certainly, this was not the case for one young man. A physician noted "the dissimilarity between his complaint and his pathology was striking."
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Failure to Involve Cardiology Common Allegation in Missed STEMI
Involving cardiology in the STEMI decision-making process can be legally protective for EPs. But as one attorney warns: “What ED practitioners need to be wary of is doing it halfway."
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Noncompliance With STEMI Guidelines Problematic in ED Claims
A recent investigation revealed that when it comes to obtaining an early ECG, there is a high degree of variability across EDs.
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New Technology Aims to Identify Patients for Safe Discharge
A noninvasive diagnostic tool that measures the heart’s magnetic activity showed promise in a recent trial. However, researchers caution that more discovery is needed before the technology can be fully integrated into standard practice.
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STEMI May Be in ED Waiting Room: ‘Devastating’ Consequences
Was an MI patient sent to the waiting room? It is highly possible an ED nurse failed to convey important information, as multiple malpractice cases make clear.
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Was It a Missed STEMI or Just Too Early to Identify?
A STEMI pattern may develop minutes, hours, or days after a patient’s initial presentation. When this occurs, the case appears to be a “missed STEMI,” even though the STEMI pattern was not present on the initial ECG.