Missed diagnosis - just a vent

[Nascar nurse]

Just trying to understand how this happens & thank God I knew enough to save myself.

Went to the ED over the weekend with complaints of horrible calf pain and swelling and a prior history of a DVT. ED was very crowded and staff very busy. Was put on a gurney in the hallway and told someone would be with me soon. Lab showed up and drew blood, transport person showed up and escorted me to ultrasound (which was done) and back to ED to wait for results. Sat in ED a total of 3 hours before a nurse or MD ever came to room to actually look at my leg. Nurse shows up and does brief assessment & admits "I think you got lost in the shuffle today". NP comes to room shortly after nurse leaves and tells me US shows no clot and I'm free to leave.

Next morning my calf is more swollen and way more painful! Call my primary MD and go in for visit. She tells me an US is rarely wrong & gives me a look like "Oh brother, another nurse with a self diagnosis". Long story short I insisted on a d dimer and she finally gives in. She calls me later in the day to congratulate me on a good call and informs me my d dimer is 3000. Was started on Lovenox and coumadin last night. Second US today confirms a clot from mid thigh to lower calf - 100% occlusion.

Now this didn't develop in just 2 days. I'm really gonna be angry when I get this hospital bill.

[AprilRNurse]

Trust me.. I'm very well aware of this. Did you read sequence of events in first post?

Did I mention that as of this point not a single health care provider has listened to my lungs. I find that odd too, although I am not having any outward signs of respiratory distress.

That is very odd, though classic PE symptoms are clear lungs with resp distress.

Good call! It's hard as a nurse to balance sticking up for yourself, and being paranoid. You made the right decision!

[gr8rnpjt, RN]

I can understand your concern about calling the insurance company, however, chances are the bill will still be paid, but the hospital will be flagged for a quality issue. Too many quality issues and the hospital could lose their contract with the insurance company. Either way, good call on diagnosing yourself.

[nursej22, MSN, RN]

For sure I would contact the hospital's risk management department. They may choose to settle with you to avoid any lawsuit and bad publicity.

Glad that you finally received the appropriate diagnosis and treatment.

[HamsterRN, ADN, RN]

So they drew blood first and then did the U/S but the blood draw didn't include a d-dimer? That does sound like bad form if they were concerned enough to do the U/S but didn't think to run a d-dimer first.

[merlee]

So I told the ER doc I was extremely fatigued, sometimes SOB, could barely walk 15 feet from my bed to the bathroom. Long family hx of cardiac and diabetes issues. Mom never had chest pain. Just extreme fatigue. "OH, but your markers are fine! Your EKG is great!"

Begged for a cath, anyway. Three occluded arteries, one too small to treat. So two balloons and stents later, I said to the cardiolgist - - 'I told you I was sick'.

Not everything shows up on the tests.......

[iluvivt, BSN, RN]

Just curious what was the ED explanation for your symptoms then? Goes to show you..NEVER forget to look at your pt and look at the whole picture and not just one test and this should have included your history . Nurses are good at that obviously.

[Nascar nurse, ASN, RN]

So they drew blood first and then did the U/S but the blood draw didn't include a d-dimer? That does sound like bad form if they were concerned enough to do the U/S but didn't think to run a d-dimer first.

That's correct the hospital did not do the d dimer & at the time they drew blood I never though to ask for one. The ultrasound had not been done yet & I really expected that would come back positive. Even my primary Dr. was reluctant to do the d dimer the next day because it's just not that reliable.

To iluvivt - The ED diagnosis was pulled muscle with an Rx for flexeril. I never filled the flexeril as I figured it wasn't going to fix my problem

[mige]

Just curious what was the ED explanation for your symptoms then? Goes to show you..NEVER forget to look at your pt and look at the whole picture and not just one test and this should have included your history . Nurses are good at that obviously.

funny that she was seen by 2 nurses in teh ED, an MD and the technician read the US as negative.