Although myocardial infarction is a common disease, due to the dangerous morbidity and high mortality rate of some patients, it is easy to cause medical disputes.
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1. Myocardial infarction is misdiagnosed and easy to cause medical disputes.
The symptoms of myocardial infarction in most patients are typical, such as severe pain or chest tightness in the precordial area, accompanied by heavy sweating, but a small number of patients have atypical symptoms, and the symptoms that are easy to cause missed diagnosis are mainly the discomfort of the neck, shoulders and back, which is considered by doctors as cervical spondylosis, or the pain site is in the upper abdomen, accompanied by nausea and vomiting, and tenderness when palpating the upper abdomen, which is considered by doctors as gastrointestinal diseases. After myocardial infarction is misdiagnosed, treatment will definitely be delayed, because the disease has a strict treatment time window, which requires thrombolysis within 6 hours and emergency PCI within 12 hours, and the longer the delay, the more necrotic myocardium, the worse the prognosis;
2. Common diagnosis and treatment mistakes in hospitals.
1. Differential diagnosis is not made when other diseases are considered.
For patients with atypical symptoms, it is necessary to first consider that other diseases themselves are not at fault, but they need to be identified and diagnosed, especially if acute coronary syndrome (ACS) cannot be ruled out, then auxiliary examinations such as electrocardiogram, cardiac enzymes, and troponin should be improved, such as dull pain with a sudden onset, from the neck to the umbilicus, and routine screening should be performed to rule out ACS. However, there are always some doctors who are overconfident and do not routinely improve electrocardiogram and other examinations, resulting in misdiagnosis.
2. Misdiagnosis of ECG.
The typical ST-segment elevation myocardial infarction electrocardiogram is basically seen by a doctor, but if the elevation is not obvious or does not show the ACS of ST-segment elevation, most non-cardiologists will not see it, and it does not mean that they can be exempted, and when the ECG is abnormal and ACS cannot be ruled out, the attending doctor should arrange a cardiology consultation, or submit the electrocardiogram to the electrophysiology department for diagnosis. It can be said that most of the cases of myocardial infarction that are misdiagnosed are that the ECG cannot be seen, and the doctor trusts the ECG diagnosis made by the computer too much.
3. Monitoring electrocardiogram, cardiac enzymes and other indicators are not in place.
Some doctors suspect that the patient has coronary heart disease, and also do electrocardiogram, cardiac enzymes, troponin and other tests, the results are basically normal, but when the patient's symptoms continue or aggravate, there is no dynamic monitoring according to the diagnosis and treatment process of coronary heart disease, because many ACS patients do not necessarily have typical changes in electrocardiogram and enzymology when they are treated, and the relevant indicators of myocardial infarction themselves will have a dynamic evolution process, so when ACS is highly suspected, changes in electrocardiogram and enzymology should be dynamically observed. Some physicians lack this knowledge and think that ACS will be ruled out as long as there is no problem after one examination.
4. Neglect of observation.
This situation mostly occurs in the emergency department, because there are many patients, and the emergency doctor is busy, it is easy to ignore the patients with atypical symptoms and painful expressions, and do not improve the ECG, cardiac enzymes and other indicators in the first time, and wait for the patient's condition to be very serious before the ECG examination, it is too late. Mr. Lin usually receives cases where patients die from myocardial infarction in a chair in the lobby of the emergency department.
5. The treatment process of acute myocardial infarction is not actively initiated.
Once acute myocardial infarction is diagnosed or highly suspected, the treatment process should be started immediately, and cardiology consultation should be invited, antiplatelet aggregation drugs, thrombolysis or emergency PCI should be actively transferred to a higher-level hospital in a hospital with limited conditions, because the technical maturity of acute myocardial infarction treatment technology is very high, so each of the above treatments has guidelines or consensus for strict time regulations, and emergency departments and cardiologists should be familiar with these processes, otherwise it is easy to make mistakes that delay the condition.
3. Precautions for protecting the rights of the patient.
1. Initiate the autopsy procedure if necessary.
Many myocardial infarctions are misdiagnosed to the death of patients, although it is highly suspected that the death is caused by myocardial infarction, but there is still a lack of evidence, such as no electrocardiogram, troponin, only highly suspected symptoms, sudden death manifestations to presume, some even died outside the hospital, this situation to go through legal procedures, must do autopsy, otherwise the appraisal agency will generally not accept, will lead to the patient to provide evidence can not lose the lawsuit, of course, the patient died in the disputed hospital, the hospital did not inform the relevant provisions of the autopsy.
2. Fix the outpatient and emergency medical records and the first electrocardiogram and other evidence.
The vast majority of myocardial infarction is misdiagnosed in the outpatient clinic or emergency department, and most of the patients are misdiagnosed when they do the first ECG, and the patient is later diagnosed in the inpatient ward or dies with a change in condition, to prove that the hospital has a diagnosis and treatment fault, it is necessary to have an outpatient medical record and the first ECG, but many patients think that it is okay to have an inpatient medical record, and do not print the outpatient and emergency medical records and electrocardiogram, resulting in the inability to identify the fault of the hospital.
3. Fixed surveillance video of patients being ignored in the examination room or emergency room.
A considerable number of patients died in the outpatient and emergency department due to neglect of their condition, the doctor did not consider ACS first, they were put aside, the electrocardiogram was not done, and the ECG monitoring was not, and there were errors in the rescue process when the patient's condition suddenly changed, but these situations will never be recorded in the medical record, and even fabricate the complaint and condition change that do not conform to the ACS, resulting in the patient's inability to provide evidence, so if possible, the surveillance video of the outpatient and emergency corridor and the emergency room must be copied.
4. The proportion of responsibility of the hospital is not too high.
The treatment process of myocardial infarction needs to race against time, and the myocardial cells are not regenerated after necrosis, the inherent onset characteristics and high mortality rate of the disease, in most cases, the cause of the patient's damage is their own disease, so no matter how outrageous the fault of the hospital is, it is difficult for the appraisal agency to identify the hospital to bear the same or more responsibility, most of the patients even if the treatment is more timely, the proportion of the hospital's misdiagnosis fault responsibility is secondary to the same, if the dispute is resolved through negotiation with the hospital, the patient should not expect too much.
It is hoped that the above experience will be useful to the affected party in dealing with this kind of dispute.