Why
is Pulmonary Embolism So Sneaky?
Five
months ago, on my first day of work at a new location as a CNA, I went to work feeling
very excited. For those of you who don’t know, Certified Nursing Assistants (CNA)
work under the supervision of a nurse to provide the healthcare needs of
patients. The scope of practice is very basic as we are not certified in
anything remotely complicated. We help with ambulating, feeding, bathing, etc.…
Anyway, I was called to assist a rehab patient with a right ankle fracture with
transferring into bed. When I walked in she was the picture of health… in good
shape, happy and breathing. She did not appear to be in distress, all was well.
The task took maybe three minutes after which I took my leave. About five
minutes passed when the patient’s husband called me back in stating the patient
had difficulty breathing. I went in and immediately confirmed the observation,
the patient was gasping for air. I immediately reported this to my supervisor
and we started to figure out the prognosis. I took her vitals; her O2 sat was
78% and dropping, her blood pressure was some other absurdly low number, her
pulse was about 130, and the most alarming symptoms to me, chest pain and extremely
cold clammy skin. By the time we realized the gravity of the situation and
called 911, it was too late. When the EMTs arrived, half of her face was blue.
A code blue (cardiac arrest) was declared, resuscitation failed, and I went on
a guilt trip for a few months. How could I miss it? In hindsight, It’s so
obvious!
Turns out, one in three pulmonary
embolism patients are misdiagnosed, by doctors, trained professionals! Their
reason differs from mine in that I had no idea what I was dealing with and it
happened so fast while their misdiagnosis stems from the fact that their
patients have other conditions with overlapping symptoms. In any case, we need
better screening methods for certain conditions in healthcare.
Citation: Henderson, Dietra. "Pulmonary Embolism Misdiagnosed in 1 of 3 ED Patients." Medscape, WebMD LLC, 23 Sept. 2013, https://www.medscape.com/viewarticle/812120.
Posted by Sarah Kamukala (2)
Wow, thanks so much for sharing your story. That seems like a traumatic experience, especially since you're not certified to do much without supervision as a CNA. I agree that there should be better screening methods. It's sad and frustrating to think how many people are misdiagnosed. I'm not familiar in this area, so I was wondering, as a CNA what would you suggest in taking action for better screening methods? All I could think of is to have multiple doctors diagnose an individual.
ReplyDeletePosted by Angelina Weng (3)
To be honest, I'm not sure. I did not look at the patient's chart, she may have been on blood thinners. They decrease the risk but it doesn't mean that there's no risk. It may have been an unfortunate case. Some people, if they are lucky enough, exhibit symptoms before the clot reaches the lung. This way, a doctor has more time to screen, make a diagnosis and treat. I'm not sure that there was time to do much of anything on my part because it happened too quickly and there were no doctors on site. We might benefit from better screening methods for people with multiple diagnoses as this is the area of trouble. I have read of many cases in which people go to the emergency room only to get sent home. This is too sad for me as it is a case in which there is a chance of catching it early on.
DeletePosted by Sarah Kamukala
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It seems that the signs and symptoms of a pulmonary embolism are closely related to the symptoms of a heart attack as well as a few other things. Is there anything that can be done to treat the patient at the CNA level? It sounds like the best thing you can do is exactly what you did - alert your supervisor. Can you go into a little more detail about the signs of someone having a pulmonary embolism? I'm curious about what can be done to prevent it, as well as what would cause doctors to misdiagnose them so frequently.
ReplyDeletePosted by Natasha Dalton (1)
You are right, all I could have done was alert my supervisor. I feel guilty because the symptoms are pretty much uniform across the board. Maybe if I took a few seconds to look up the symptoms on my phone I could have saved her life by alerting emergency technicians of what they were walking into. The symptoms include shortness of breath, chest pain, clammy skin, irregular heartbeat, among others. I know for sure that this incident has provided me the necessary education and ambition to prevent history from repeating itself.
DeletePosted by Sarah Kamukala
This is such a tragic story of misdiagnosis. And it's even more sad to think that countless other patients share similar tales. It's tricky because the onset of symptoms stemming from a pulmonary embolism can be so rapid. I work as an EMT so this story really strikes a chord with me because even as a first responder, there really isn't much I can do for PE patients except rush them to the ER and provide CPR if they go into cardiac arrest en route. I agree that better screening methods would be helpful, but from the doctor's perspective I see why it is nearly impossible to detect a PE until its symptoms become critical. Maybe preventative approaches, such as prescribing blood thinners to potentially at-risk patients, could be implemented more strongly into a doctor's regimen.
ReplyDeletePosted by Nicole Ayres (1)
This is such a sad situation and I am so sorry to hear that you had to go through this. I am also a CNA and can not imagine what I would have done if i were in your situation. You seemed to handle the situation to the best of your ability, drawing attention to the situation right away. It is so unfortunate that this occurred so quick but the type of work in this field is so unpredictable.
ReplyDeletePosted by Sarah Aboody
That is quite the story, I can't imagine what I would do in that situation. It is very unfortunate that misdiagnoses do occur. The signs and symptoms are very similar among diseases so that makes it hard to correctly diagnose 100% of the time. Hopefully we can develop better methods to ensure that this does not happen as much.
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