Patient Found Pulseless After Allegedly Negligent Emergency Room Triage

This case involves a 49-year-old female patient with a history of high blood pressure who was brought to the emergency room with unbearable chest and abdominal pain. The patient’s blood pressure was read as extremely elevated and the physician assistant decided to administer several labs in the emergency room triage. When the test results came back, the physician assistant concluded that there was no emergent medical condition. The patient was then left alone for 3 hours without further evaluation or treatment before she was found pulseless. The patient required intubation and suffered from severe tracheal stenosis following her recovery. An expert physician’s assistant was sought to discuss the standards for triaging patients in the emergency room.

Question(s) For Expert Witness

1. How often do you treat patients who present to the ER with similar symptoms?

2. What would be the appropriate workup for a patient with these symptoms?

Expert Witness Response E-037232

Throughout my 21 year career as an emergency medicine physician's assistant and physician assistant educator, I have treated thousands of patients who have presented with similar symptoms. In my opinion, any patient who presents with these, first and foremost, must have a 12 Lead ECG obtained to evaluate the presence of a ST-elevated myocardial infarction (STEMI), and the patient must be placed on an ECG monitor. The patient triage should have then resulted in moving the patient to the main emergency room. The appropriate standard of care then dictates obtaining a baseline Troponin-I Level followed by a repeat level in four hours. The standard of care also for patients who present to the emergency department must provide an appropriate medical screening examination to rule out an emergent medical condition. The differential diagnosis should include, but not be limited to: pulmonary embolus, CHF exacerbation, pneumonia, sepsis, DKA. I have reviewed several cases similar to this one in the past few years.