Hospital Patient With High Blood Pressure Dies After Premature Discharge

Case Overview

This case involved a 43-year-old female patient who presented to the emergency room following a motor vehicle accident. The patient complained of neck, shoulder, and hip pain. Upon exam, she was noted to have extremely high blood pressure. It was later discovered that the patient had not taken her antihypertensive medications. The patient was diagnosed with a muscle strain of the upper back and discharged home. One month later, the patient returned to the emergency room complaining of worsening back pain and spasms. Upon exam, she was noted to have paraspinal tenderness and spasms of the lumbar spine. Her blood pressure was also noted to be elevated. HEART scoring noted an elevated risk of adverse cardiac events. However, the patient was diagnosed with a muscle spasm of the back and discharged home. Several hours later, the patient was found in the emergency room parking lot unresponsive, apneic, and pulseless. The autopsy report noted the cause of death as cardiac tamponade due to a ruptured aortic aneurysm. An expert in emergency medicine was sough to review the patient’s medical record and opine on the care she received during the two emergency room visits prior to her death.

Questions to the Emergency Medicine expert and their responses

How often do you evaluate patients who present to the emergency department with severe hypertension?

I evaluate severe hypertension about twice a shift, so 20-30 times per month.

In patients who present with a hypertensive urgency or emergency, what are the most pertinent elements of the diagnostic workup and which criteria do you utilize to determine fitness for discharge?

In patients who have a high blood pressure, pertinent elements of the work up are what other symptoms the patient is having and how indicative they are of end-organ damage (chest pain, urinary issues, headache, shortness of breath). Asymptomatic high blood pressure can be treated and discharged as long as the pressure is decreasing. You should not decrease a patient's blood pressure more than 20% in one visit unless there are obvious indications, such as a head bleed.

About the expert

This highly credentialed expert has degrees in mechanical engineering from both UT Austin and Stanford University, and a PhD in bioengineering from Rice University. In addition to this training, he earned his MD from Baylor and is a practicing emergency medicine physician. He has published several peer-reviewed works in his field and spoken about biomedical and biomechanical engineer at conferences in the US and abroad. He is a member of professional organizations including the American Society of Mechanical Engineers and the Arkansas Governer's Trauma Advisory Council, and is the president-elect of the Arkansas chapter of the American College of Emergency Physicians. He holds hospital appointments aa an attending emergency physician at three hospitals, and is the medical director of trauma for an emergency department at one of them.

E-374078

Specialties:

Emergency Medicine

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.