Sudden Death Errors

Here’s a list of potential critical errors in various clinical scenarios:

  1. Cardiovascular Issues:
    1. Administering nitroglycerin (GTN) to a chest pain patient with systolic BP <95 mm Hg or who has taken phosphodiesterase inhibitors (like Viagra) within the last 24 hours.
    2. Missing a diagnosis of aortic dissection in a patient with chest pain and neurological symptoms.
    3. Missing a diagnosis of esophageal rupture (Boerhaave syndrome)
  2. Respiratory Issues:
    1. Not giving oxygen to a hypoxic patient.
    2. Giving high flow oxygen to a patient with COPD
    3. Giving oxygen to an ALS patient with Sa02 >= 94%
    4. Not intubating a patient with declining respiratory function and increasing hypercapnia (raised CO2 levels).
  3. Allergic Reactions and Anaphylaxis:
    1. Not administering adrenaline to a patient showing signs of anaphylaxis.
    2. Administering adrenaline to a patient who only has urticaria
    3. Giving beta-blockers to a patient with a history of severe allergic reactions, as these can exacerbate anaphylaxis and make it harder to treat.
  4. Neurological Issues:
    1. Not recognizing and treating increased intracranial pressure in a patient with a head injury.
    2. Missing a diagnosis of meningitis or encephalitis in a febrile patient with neck stiffness and altered mental status.
    3. Missing a diagnosis of cauda equina or spinal cord compression.
  5. Pediatrics:
    1. Not considering non-accidental injury in a child with inconsistent injury history.
    2. Missing a diagnosis of intussusception in an infant with colicky pain and “red currant jelly” stools.
  6. Pregnancy/Contraception:
    1. Not evaluating for ectopic pregnancy in a woman with abdominal pain and spotting
    2. Missing a diagnosis of preeclampsia in a hypertensive pregnant woman with proteinuria and/or swelling
    3. Not performing a pregnancy test before starting contraception
    4. Prescribing the combined oral contraceptive pill (COCP) to patients with MEC4 contraindications ie:
      1. Migraine with aura (stroke risk)
      2. Age ≥ 35 years and smoking ≥ 15 cigarettes per day.
      3. Diabetes with
        1. nephropathy/retinopathy/neuropathy
        2. >20 years’ duration.
      4. Breast cancer.
      5. Cirrhosis (severe) or liver tumor (malignant).
      6. Major surgery with prolonged immobilization.
      7. Vascular
        1. Hypertension ( ≥160 mm Hg or diastolic ≥100 mm Hg).
        2. History of DVT or PE (not on anticoagulant therapy).
        3. Ischemic heart disease.
        4. Stroke.
        5. Complicated valvular heart disease.
        6. Known thrombogenic mutations.
        7. Systemic lupus erythematosus (SLE) with positive antiphospholipid antibodies.
  7. Endocrine Issues:
    1. Not giving steroids to a patient with known adrenal insufficiency who is under stress.
    2. Missing a diagnosis of diabetic ketoacidosis in a diabetic patient with abdominal pain, ketones, and acidosis (with SGLT2 BSL can be lower than usual for DKA)
  8. Infections:
    1. Not giving tetanus prophylaxis in a patient with a dirty wound.
    2. Not considering sepsis in a febrile patient with hypotension and altered mental status.
  9. Drugs and Toxins:
    1. Administering a drug to which the patient has a known severe allergy.
    2. Not considering opioid overdose in a patient with respiratory depression and pinpoint pupils.
  10. Trauma:
    1. Not immobilizing the cervical spine in a trauma patient with a potential neck injury.
    2. Not assessing for internal bleeding in a trauma patient with hypotension and abdominal tenderness.
    3. Not following primary/secondary/tertiary survey approach