Foot infection after foreign body leads to gangrene, toe amputations (Case #311)

• Medical Probability: 10 / 10
• Medical Error Summary: The visit on 6/15/22 shows a tachycardia of 130 which according to the limited summary provided was unexplained. Patients should never be discharged from the emergency department with a heart rate of ...
• Causation Probability: 8 / 10
• Causation Summary: Had she been admitted on 6/15/22, she would have had a more complete evaluation of the foot infection with imaging studies such as an MRI scan which would have identified a deep tissue abscess. She wo...
• Expert Summary: I am board certified in Emergency Medicine by the American Board of Emergency Medicine. I am board certified in Internal Medicine by the American Board of Internal Medicine. I am board certified in Cr...
• Similar Summary: Diabetic patients with foot infections are commonly seen in the emergency department. Throughout my forty plus years of practice in a level 1 trauma center emergency department, I would estimate tha...

Death After MVC (Case #329)

• Medical Probability: 6 / 10
• Medical Error Summary: Unfortunately, there is a lot of information missing. The patient had multiple trauma but came in to the ED hemodynamically stable. The only gross physiologic abnormality was the severe hypoxemia of 7...
• Causation Probability: 6 / 10
• Causation Summary: More information is needed as discussed above.
• Expert Summary: I am an emergency medicine physician with substantial professional experience over the past forty plus years while assigned to provide emergency medical coverage in a general acute care hospital level...
• Similar Summary: Several trauma cases every week.

ER Treatment of Rocephin-Induced Anaphylaxis (Case #379)

• Medical Probability: 9 / 10
• Medical Error Summary: The history is very limited and inconsistent. We need to know if the patient had any allergies or a history of anaphylaxis to determine if giving Rocephin was appropriate. Once it was obvious that he ...
• Causation Probability: 8 / 10
• Causation Summary: Inappropriate treatment of the anaphylactic reaction, making his respiratory status worse by administering sedating and narcotic medications, delay in intubation for airway control and ventilation and...
• Expert Summary: I am board certified in Emergency Medicine by the American Board of Emergency Medicine. I am board certified in Internal Medicine by the American Board of Internal Medicine. I am board certified in Cr...
• Similar Summary: Allergic reactions are commonly seen in emergency departments. Anaphylactic reactions are much less common but in my 40+ years of practice in a level 1 trauma center, I would estimate that I have seen...

Stroke Symptoms ignored leading to death (Case #486)

• Medical Probability: 10 / 10
• Medical Error Summary: Blood pressures such as 226/132 on discharge are considered hypertensive emergencies. The patient should not have been discharged with an uncontrolled blood pressure of this magnitude. The risk of a s...
• Causation Probability: 10 / 10
• Causation Summary: The failure to control the patient's blood pressure was likely the cause of her stroke the next day. The timing of her symptoms before presentation to hospital # 2 is not detailed but if the last kno...
• Expert Summary: I am triple board certified in Emergency Medicine, Internal Medicine and Critical Care. I have 40 years of experience in medical-legal case evaluations and have reviewed more than 2000 cases. I have ...
• Similar Summary: I encounter similar cases on at least a weekly and sometime daily basis.

54yo M Intoxicated MVC Patient Released Without Head CT; Later Fatal Subdural Hemorrhage (Case #556)

• Medical Probability: 8 / 10
• Medical Error Summary: This report addresses whether the standard of care required CT imaging of the head, and cervical spine imaging, based on the clinical presentation described. The analysis relies on widely accepted eme...
• Causation Probability: 8 / 10
• Causation Summary: Had imaging of the head been performed, it is more likely than not that the subdural hematoma would have been identified, the patient would have been admitted to the hospital, and an emergency neurosu...
• Expert Summary: I am board certified in Emergency Medicine by the American Board of Emergency Medicine. I am board certified in Internal Medicine by the American Board of Internal Medicine. I am board certified in Cr...
• Similar Summary: Over the course of my 40+ year career, I have evaluated major trauma cases such as the present case on a daily basis.

Neuroleptic Malignant Syndrome (Case #576)

• Medical Probability: 8 / 10
• Medical Error Summary: The patient is a 50-year-old male who presented to the emergency department accompanied by his mother, who served as the primary historian due to the patient’s limited ability to provide history. ...
• Causation Probability: 8 / 10
• Causation Summary: As a direct result of these deviations, the offending medication(s) were not discontinued, supportive measures to prevent progression of disease were not initiated, the patient was exposed to a forese...
• Expert Summary: I have more than 40 years of experience in the full time practice of emergency medicine in a busy level 1 trauma center. I am triple board certified in emergency medicine, internal medicine and critic...
• Similar Summary: Although relatively rare, NMS is seen a handfull of times per year in a busy level 1 trauma center such as the hospital in which I practice.