Most times a patient that is triaged with a specific chief complaint ultimately have a diagnosis that appears to relate to that complaint. Such as “chest pain” often results in a diagnosis of “unstable angina” or “pulmonary embolus.”
Occasionally, something will be a little different like “back pain” turns out to be “biliary colic” or “myocardial infarction.” Still, those are not surprising.
However, once and a while you have a chief complaint (or something that the triage RN writes down) that does not appear to match the ultimate diagnosis you reach at all. In retrospect, if you just read the triage note or chief compliant, you really can’t believe that the diagnosis was what it turned out to be. Here are some examples that I recall that fit that category.
1. “Flank pain r/o kidney stone” turned out to be “acute arterial occlusion of the femoral artery.” This was a recent case that I had that because the patient was a vague historian, had a history or chronic pain from things like OA and spinal stenosis, the fact that the real problem was that her left leg was less well perfused than the right was easily overlooked.
2. “Chest pain” turned out to be “testicular cancer.” In this one the patient had chest pain that sounded like it might have been an aortic dissection and got a CT of the chest and the upper abdominal aorta. It showed periaortic lymph nodes only. It was only then that he mentioned his scrotum felt enlarged and we found he had a big fat tumor there.
3. “Headache” turns out to be “acute angle closure glaucoma.” Not really that bizarre but fairly uncommon in the absence of specific eye complaints.
4. “Ear pain” was in fact “unstable angina.” Actually this was not really related. The guy came in for the ear problem (which was nothing) but then mentioned almost casually he had been have chest pain and shortness of breath on exertion and was admitted.
ER Stories is an emergency physician who blogs at his self-titled site, ER Stories.
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