A 50-year-old obese female patient was followed by the same practice for 12
years, beginning in 1992. During this time, the patient, a teacher who spends all
day on her feet, was evaluated twice for leg pain and swelling. Ultrasounds both
times to rule out DVT were normal.
In November 2003, six years after the last test for leg pain, the patient was seen
by a covering physician for sore throat, runny nose, headache, and an ongoing cough
of 10 days duration. She was a non-smoker who took oral contraceptives intermittently,
and had recently completed a long airplane ride. The physician prescribed amoxicillin;
10 days later, the patient called to report no improvement. The covering physician
prescribed another round of amoxicillin and bactrim for her cough. She was asked
to come in if the symptoms did not resolve.
The patient did not return until January 9, 2004. She was seen in the office by
a covering physician for complaints of cough, fever, chills, and shortness of breath,
ongoing for the last few weeks. When evaluated, she had a temperature of 98.2 degrees,
pulse 88, respirations 14, and blood pressure 120/80. She was diagnosed with bronchitis
and prescribed zithromax, decongestants, steam and robitussin. She was asked to
follow up in one week. Later that day the patient called the physician’s office
to report that she was experiencing an episode of tachycardia at 120 beat per minute
(per the school nurse where she worked). She was advised to start her medications,
hydrate, and to get some rest.
On January 12, 2004 the patient returned to the office for follow up on her bronchitis
and was seen by her PCP. She reported that her cough had not resolved. In the office,
the patient’s respirations were 18 and her oxygen saturation was 88 percent. The
patient was given a DuoNeb, which diminished her cough. The patient was also sent
for chest X-ray, which was normal. The PCP diagnosed her with bronchitis with an
asthmatic component. The patient was to continue with the zithromax, add a Medrol
Dosepak, and an albulterol inhaler.
On January 16, 2004, the patient returned to the office with an ongoing complaint
of shortness of breath and difficultly breathing. She was seen by her PCP and stated
that she has had no improvement from any of her past medications, which included
zithromax, guaifed, prednisone, Tessalon, Medrol Dosepak, and albulterol inhaler.
During the patient’s workup, her blood pressure was 140/100, pulse 120, temperature
97.8 degrees, respirations 28, pulse oximetry was 96-97 percent on room air and
her lungs appeared to be clear. The patient was diagnosed with subjective shortness
of breath with probable bronchitis. She was advised to finish the Medrol Dosepak,
use her albulterol inhaler prn, and start Advair. The patient was instructed to
return to the office for follow up in four or five days.
She died the next day from a pulmonary embolism.
