Sample Case: Missed Diagnosis in Emergency Department
Sample Scenario
In this sample scenario, a 42-year-old patient presents to the emergency department with complaints of severe headache, nausea, and sensitivity to light. After a brief examination, they are diagnosed with a migraine and discharged with pain medication. 36 hours later, the patient suffers a major stroke resulting in permanent disability.
LNC Approach
In a case like this, our legal nurse consultant would conduct a comprehensive review of all relevant medical records, including:
- Emergency department triage notes and vital signs
- Physician and nursing documentation
- Laboratory and diagnostic test results
- Medication administration records
- Previous medical history from primary care visits
Potential Findings
A thorough medical record review in this type of case might uncover issues such as:
- Elevated blood pressure readings that were not addressed
- Documentation of "worst headache of life" – a red flag for potential stroke
- Family history of stroke that was documented but not considered
- Standard stroke assessment protocols not being followed despite presenting symptoms
- Inadequate discharge instructions lacking warning signs that would necessitate return to the ED
Potential Impact on the Case
A detailed analysis like this could provide the foundation for establishing whether the standard of care was breached. The medical record review might reveal a pattern of missed opportunities to diagnose and treat the patient's condition before it progressed to a catastrophic stroke.
In similar cases, this type of comprehensive review has helped legal teams identify key medical issues, establish timelines of care, and determine if proper protocols were followed.