A tale of three midlevel mistakes in the ED

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Anonymous emergency physician submission

I’ve made it a priority to see every NP/PA patient, even at the expense of picking up new patients of my own. In the past month I’ve caught the following errors:

1. Patient with known posterior compartment injury of the thigh, recently discharged from being admitted for the same, on anticoagulants for DVT found during said admission, returns with worsening leg pain, numbness, and diminished pulses distally. Maybe the most obvious compartment syndrome I’ve ever seen. Patient was never presented to the physician who was on shift when I came on. Workup was limited to basic labs and an X-ray of the femur (lol). I told the NP I would be taking over care of this patient, immediately after I called ortho.

2. Diabetic patient with severe back abscess. Was in DKA. DKA was missed by the NP until I pointed out the labs to him.

3. Patient presents with worst headache of her life, refractory to ibuprofen that “always relieves my headache. It’s also wrapping around the back of my head and I’m nauseated.” Patient was treated by NP with migraine cocktail including Toradol. I insisted she order the head CT. Subdural hemorrhage, admitted to NSGY.

None of these patients had been discussed with a physician. I am not in an independent practice state. These experiences have reinforced my desire to continue seeing all NPP patients, even at the detriment of my own patients per hour. To my Emergency Medicine colleagues, stay vigilant, and always protect your patients. It’s a minefield out there.