Early in my career as a Houston, Texas medical malpractice lawyer, I handled a case involving a teenager who was involved in a high-speed car wreck. He was not wearing a seatbelt at the time and ended up being ejected through the front windshield.
As you might expect, when an ambulance took him to a Clear Lake area hospital emergency room, he was really bruised and beaten up, with glass and other debris in his face. The ER doctors and nurses gave immediate attention to stabilizing him and then cleaned up his face.
Unfortunately, it took them hours to discover that he had a life-threatening aortic dissection. By the time the suburban hospital providers discovered it, they could not transfer him to the Texas Medical Center for vascular surgery before he was permanently paralyzed from the shoulders down.
I think about that young man often, and how his life-changing paralysis could’ve been avoided with proper care.
The standard of care requires emergency medicine physicians—just like all doctors—to use the differential diagnosis process to arrive at a formal diagnosis and treatment plan. This involves assembling a list of every potential diagnosis that would explain a patient’s signs and symptoms. Rather than rushing to a conclusion that could be wrong, doctors are required to rule out each potential diagnosis from the last, starting with the most dangerous one.
When this young man entered the emergency room, healthcare providers should have recognized that he experienced a blunt trauma injury. This means that the patient’s entire body was thrown against or impacted something—in this case, the car windshield—suddenly causing it stop.
Imagine what such an impact could do to internal organs—thrusting forward, hitting a sudden stop, and then moving back into place. Blunt trauma injuries require a differential diagnosis evaluation of several life-threatening injuries, including traumatic aortic dissection.
An aortic dissection means that there is a tear in the aorta. The adjective “traumatic” means that the tear was caused by the physics of blunt trauma. With each pulsing heartbeat, and aortic tear can become larger, meaning that time is of the essence in repairing an aortic dissection.
For many people involved in an automobile collision, the location of the aortic tear will cause almost instant death at the accident scene. In fact, the most common cause of death of the scene of a serious car wreck is a descending thoracic aorta dissection associated with deceleration.
When patients survive the accident and are successfully transported to the emergency room, doctors must quickly consider the patient’s status and give attention to the most life-threatening injuries, like a potential aortic dissection. Emergency physicians are trained to use the differential diagnosis process to make sure that they do not skip important steps in the diagnostic process during the stress of an emergency situation.
Telltale risk signs for an aortic dissection include a serious car wreck and unstable hemodynamic status (blood pressure and blood flow), which can be a sign of an aortic leak. In these situations, the potential diagnosis of aortic dissection must be included in the differential diagnosis list.
In these cases, the standard of care requires the emergency physician to order a radiology workup to rule out an aortic dissection. This can start with a chest CT scan and, if there are concerns with the results, followed by CT angiography (CTA). CTA is an important and useful procedure that can help identify the exact location of an aortic dissection and helps physicians decide between endovascular stent-grafting or surgical repair.
Although blunt thoracic and aortic dissection injuries following a motor vehicle accident can be fatal, prompt and early diagnosis and surgical treatment can be life-saving.
Aortic dissection can also happen even outside a car-wreck situation. Emergency medicine experts recommend that when a patient comes to the hospital with chest pain, four conditions should always be on the differential diagnosis list: (1) heart attack (acute myocardial infarction); (2) pulmonary embolism; (3) aortic dissection; and (4) unstable angina.
Whether an emergency room visit is initiated because of a car wreck or chest pain, in my experience as a Houston, Texas medical malpractice lawyer, far too many physicians rush to conclusions rather than following the differential diagnosis process. When their conclusions are wrong, they end up treating the wrong condition and needlessly put patient lives in danger.
If you or someone you care for has been seriously injured as a result of poor medical, nursing, or hospital care, call the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
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Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical malpractice and wrongful death lawsuits against hospitals, surgeons, doctors, anesthesiologists, nurse practitioners, physician assistants, pharmacies, and other healthcare providers. In 2017, he was recognized by H Texas magazine and Houstonia magazine as one of Houston’s top lawyers.
