Head or chest trauma is important for emergency room providers to know about and evaluate
Being hit in the head or chest can cause a dissection of an artery that can cause a stroke
Any time a person goes to the emergency room and reports trauma to the head or chest, it should raise red flags to the triage nurse, emergency physician, and other healthcare providers.
I recently met with a middle-aged man who rushed to help another person that was in a car crash. He tripped over some debris and landed hard on his chest. He got up, brushed himself off, helped the person, and then went back to work.
About four days later, this man woke up feeling very dizzy, along with nausea and vomiting. His wife took him straight to a hospital emergency department in The Woodlands, Texas area. They told the nursing staff and emergency room doctor about his fall to his chest days earlier. The doctor did no diagnostic testing to try to figure out why he was feeling so dizzy. Instead, the ER physician diagnosed him with vertigo and discharged him to home within three hours.
I am working on another lawsuit that is pending in Harris County, Texas, involving care that was provided at Memorial Hermann Northeast Hospital. In that case, another middle-aged man suddenly developed the worst headache of his life. That is another buzzword that should grab the attention of any healthcare provider.
This man went to a freestanding emergency room to get checked out, but they could not find anything wrong. He was diagnosed with high blood pressure and a migraine headache and discharged. When things did not get better the next day, he went to the hospital emergency room, but was discharged with the same diagnoses and with medications. On the third day, he returned to the hospital emergency room, had a head CT scan, and a neurologist consult. Once again, he was treated and discharged for a migraine headache and high blood pressure. Within a few hours of getting home on the third night, he had a massive stroke.
This man was taken by ambulance to a nearby hospital in the Kingwood area and then transferred to a hospital in the Texas Medical Center. It was not until he arrived at the Medical Center that anyone asked him if he had experienced any type of head trauma. At that point, he remembered that he had hit his head on a chandelier at work about three months earlier. Although it gave him a headache at that time, he did not think anything about it and just continued working.
Potential danger of a diagnosis of exclusion
These two real cases illustrate the danger of a physician, physician assistant, or nurse practitioner settling on a diagnosis of exclusion, like vertigo or migraine headache.
In the medical field, a diagnosis of exclusion is something that the doctor arrives at only after doing a full battery of tests and evaluations to rule out every potential cause of the patients’ signs and symptoms. Both vertigo and migraine headache are not life-threatening diagnoses. For each of these patients’ symptoms, the doctors involved did not work up or rule out some more serious diagnoses that could potentially explain their symptoms.
In both cases, the key piece of information that the healthcare providers either overlooked or did not ask about was recent head or chest trauma. In the first case, the patient and his wife reported recent chest trauma. It was front and center in front of the doctors and nurses and even referenced in the medical records. In the second case, despite going to an emergency room three days in a row, no one ever asked about whether he had experienced any head trauma. Thus, it never occurred to the patient to mention it, because he had hit his head three months ago and had thought nothing more of it.
For both patients, the head or chest trauma caused a dissection, or tear, of an artery that supplies blood to the brain. They quickly sought treatment, but were misdiagnosed and discharged from the hospital, only to later suffer devastating, life-changing strokes.
According to medical experts, in cases like this, the appropriate treatment typically involves admitting the patient to the hospital for observation and ordering anticoagulant medical therapy. Diagnostic imaging, like a CT scan, MRI, or MRA (angiogram) may also be indicated. Of course, being observed in the hospital would allow prompt attention, including surgery, if needed, should the patient’s condition became unstable.
What you can do
If you experienced unusual symptoms that cause you to seek emergency medical treatment, think carefully about whether you have experienced any type of head or chest trauma in the past six months—even if you did not seek treatment for it at the time it occurred. If so, be sure to mention it to your nurses and physicians.
If you or a loved one has been seriously injured from poor health care, call the experienced medical malpractice lawyers at Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Robert Painter is a medical malpractice and wrongful death attorney at Painter Law Firm PLLC, in Houston, Texas. He represents patients and family members and lawsuits against hospitals, pharmacies, doctors, surgeons, anesthesiologists, and other healthcare providers. He is a former hospital administrator who frequently speaks and writes on topics related to healthcare and medical negligence. He previously was the editor-in-chief of The Houston Lawyer magazine and now serves on the editorial board of the Texas Bar Journal.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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Published in the July/August 2018 edition of "The Houston Lawyer" magazine