Benign symptoms, but actually a medical emergency - examples?

Factual Questions
1

While reading this thread, I got to wondering what kind of medical conditions or injuries present symptoms that seem relatively benign, yet are a true medical emergency?

Two off the top of my head I can immediately think of are a ruptured appendix (symptoms: abdominal pain, followed by relief of that pain), and an epidural hematoma (a la Natasha Richardson). So what are some others?

The key here is benign symptoms – so a stroke or heart attack don’t qualify. The symptoms would have to be something someone could easily brush off as being something non-serious, like the above ruptured appendix (“Ooo, I shouldn’t have eaten that chili and lard taco for lunch, but I feel better now”).

2

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3

A lot of times, in women, the only symptoms of heart attack are shortness of breath and nausea.

4

My mom’s an RN and mentioned a case in the Pacific Northwest years ago where a hospital decided to cut costs by firing all their experienced RNs and hiring brand new ones at the bottom of the pay scale.

Problem was, in the obstetrics unit, they had a woman in labor experiencing excruciating pain that suddenly resolved on its own. One of the nurses was a bit concerned, left a message with the OB/GYN, but by the time the doctor called back to say “get that patient in the operating room RIGHT THE FUCK NOW”, it was too late. The woman’s uterus had ruptured - the tearing of the muscle was the excruciating pain, and when it was finally completely torn open, the pain stopped. The woman bled out into her abdomen. She and the baby subsequently died.

The husband ended up suing the hospital and winning, because while uterine rupture is fairly rare, an experienced RN would have picked up on it long before it became fatal.

5

A friend of my family had a pounding headache, lasted for a few days. At one point he mentioned that it’s the worst headache he’s had since he had his adenoids removed about two years earlier. No one really thought much of it. At one point his wife realized that he hadn’t gotten out of bed in over 24 hours so she took him to the hospital. Turns out when he had his surgery the doctor accidentally nicked a bone. The pain was an infection that went through the tiny hole and took up residence in his brain.
The result: Part of his brain had to be removed. It took him years to recover from that and he’s now a completely, 100% different person. His marriage fell apart and his restaurant, that’s been in his family for over 100 years and had about 10 locations went bankrupt…and they just thought he had a migraine.

6

A pounding headache for several days is not a benign symptom. I would think most people would see a doctor fairly quickly if a severe headache lasted more than a day. That said, there are many severe infections that can present with mild symptoms. My now deceased landlady had a septic infection for a month that she thought was just a flu. Unfortunately, it wasn’t and it ended up killing her.

7

Priapism, while not immediately lethal, is a definite medical emergency.

8

Well, heart attacks can present with benign symptoms. We had a 44 y/o male come in by EMS in full arrest (we never got him back), who’d been complaining of a little ache in his left shoulder for a couple of days, he’d thought he’d tweaked it at the new job he started the week before, oops he was having an MI.
I’ve had new onset type 1 diabetics present with non-specific abdominal pain.

9

You don’t know many migraineurs then do you … I have had a 30 day headache that put me in the ER 3 different times that was barely suppressed by heavy drugs. That is the one that got me my diagnosis. 3 and 4 day runs of migraine are not unusual for some people.

I have to admit, I get migraines, or nothing, so I wouldn’t know a basic headache if I had one. Mine always start out with auras and if I dont get meds put me into a dark bedroom in silence waiting for my head to stop hurting, or explode. At that point I wouldn’t care if a serial killer came in and blew my head off.]

Sorry, mrAru reminded me of a concussion I got, so I have had a nonmigraine headache before.

10

Unfortunately, there are lots and lots of vague or seemingly benign symptoms that can indicate impending catastrophe. But, to investigate every instance of their occurrence in order to detect the one-in-a-million time they’re serious is not just expensive and impractical, but would probably cause more net harm overall. For example, a single unnecessary CT scan is estimated to lead to a one in eighty chance of cancer (cite = New England Journal of Medicine, but I don’t think it’s free full-text access).

In any case, to add to the list, there are documented cases of an ‘itchy’ nose representing angina (i.e. a possible impending heart attack). More tragically, anyone dealing with patients on an emergency basis will have a story of the 16-year-old who seemed to have typical flu symptoms (low fever, nausea, sore throat, malaise, . . .) and was dead 12 hours later from meningococcal infection.

I’ve seen two cases of pheochromocytoma where the symptoms consisted of intermittent sensations of anxiety, panic attacks essentially. Of course, the diagnoses were missed initially and it wasn’t until the patients returned to the ER in extremis (one with pulmonary edema and the other with a BP of 280 systolic and headache) that the diagnoses were made.

Another case that stands out for me was of a young woman in her 32nd week of pregnancy. She had been feeling tired and a bit “dizzy” for the last couple of weeks. And that was it; nothing more dramatic or more specific. Hardly the type of thing to get to worked up over. Both her family doc and obstetrician told her that it was common for women to feel lousy now and then during their pregnancy and not to worry about it. Just make sure to “take your vitamins and get plenty of rest”.

Then, her cord prolapsed, the fetus was found to be ‘in distress’, and an emergency C-section was done. Still, at the end of the day, there was a healthy baby and smiling mom. Forty-eight hours later, she crashed. Low blood sugar, blood pressure almost undetectable, kidneys failing, frank psychosis, and dangerously high blood levels of potassium. She had full-blown adrenal crisis (so-called Addisonian crisis). Her earlier symptoms of dizziness and fatigue had been the only warnings. And there’s no way they gave enough indication to look for adrenal disease. (BTW, is anyone curious as to why she crashed 48 hours post-partum and not earlier, say, during her C-section)?

11

(Total WAG and please do tell, but could it be linked to meds being given to her during the C-section?)

12

Were the baby’s adrenals supporting her somehow?

13

Glucose drip during c-section?

14

Or toxic shock syndrome. I’ve mentioned this before but I had raging staph infection that so looked like a typical flu that by the time I was taken to the hospital my blood pressure was too low to support consciousness when upright.

15

Testicle pain, usually nothing but trauma but a strangled testicle can kill.

16

One of the common questions asked of a person asking for migraine relief is “Is this the worst headache you’ve ever had?” If the answer is yes, the medical personnel know to step up their awareness.

17

Baloney. I had a patient last fall that had a subarachnoid hemorrhage, a type of bleeding stroke, that blew it off as a bad migraine until it triggered a seizure. Even after that, the symptoms didn’t look like a stroke. She nearly died on me en route to the hospital, and I don’t know what happened after that.

Usually, immediate surgery is required to stop the bleed and reduce cranial pressure.

18

Not much time atm to give even one particular example of ~benign sx’s but there are plenty. I have rolled ‘walkie/talkie’ patients from X-ray/Ct-table right into elevators that head to surgical floor (not infrequently at a run). Aneurysms and ‘brain bleeds’ with way-high pressure on brain are towards top of my list - later, patient came back for rescan, and seeing someone with a ‘nail’ (device to measure pressure in cranium, per se) in top of head looks almost Borg-like I’ll say that folks with ~chronic hypertension that get a sudden weaker-side-of-body (like loss of grip-strength) in one hand, or a droopy/lazy eye should be getting their ass to a hospital muy pronto and not argue with their spouse about it for hours on end until unconscious/unable to further argue (!). Vague belly pain has often given some odd but near-death times ime as well (appendix and arterial/aortic aneurysms are aplenty). I’ll come back with one interesting ‘case’ a bit later - it was kinda neat, but probably wordy.

I gotta say THANKS for pointing out the radical (imo) increase in chance of cancer from CT’s. A hell of a lot has been learned about rads-v-effects since I started ‘ionizing’ 20+ yrs ago, and some Docs/ER-Admins are too quick to tell Nurses (often little-experienced or -knowledged ones, ime) to send all ‘headaches’ (or belly aches) for a CT, even if patient has a history of migraines for fifty years and his neuro is on vacation and has no other options over Christmas holidays (etc, etc). And since a high-% of smaller facilities (in Oklahoma for sure) do not require the Techs to know much of ALARA (‘as low as reasonable achievable’, not the better of Wiki writings, fwiw), and Oklahoma does not require Rad Techs to be registered/licensed, the energy used can be much higher than needed for diagnosis, giving much more ‘exposure’ (~risky danger) than would ever be needed. Bigger facilities do have policies of registered-only, so I am clear its not done as a rule. It is something I try to advocate at every chance since the perception is often “Oh, just scan them to save time for Doc (with rolly-eyes type attitude”. I have sat face-face with the ‘head inspector/enforcer’ of one State’s Rad Safety Office ( State-govt level, per se) and on phone more than a few times and heard off-the-record stories of deaths that were pretty much certainly to be blamed for having too many CT’s of head/body (investigative/measuring protocols for ‘new’ procedures and/or disease and ~common in teaching hospitals, ime). The statistics being generated are not in favor of ‘CT is ~safe to use’ whatsoever, but the risk can easily outweigh benefit(s) of not scanning with certain symptoms and/or overall worthy evals by properly-trained persons. A number of ER docs have told me that they have been instructed/leaned-on heavily by Admins to increase CT usage as the reimbursement is great/not argued about by Ins companies much. My personal thanks/respect to all the Docs that stand their ground for patient-safety.

X-ray Depts are cash-cows, so Admin often loves scanning everyone possible, but it seems word is getting out ‘publicly’ about the dangers of ‘scanning-by-protocol’. Off my pedestal now - always always always demand the CT/X-ray Tech knows how to do things (ARRT is the ‘standard’) and is not working off a ‘check-list’/operator’s manual made up by someone to just get images at whatever the risk/cost. Doc should be able to explain clearly and unequivocally why it is needed to put health/safety at risk for a diagnosis - some cannot/will not answer that question, trust me.

19

Sure they could - people are infamous for mistaking a heart attack for indigestion or heart burn, or a sore shoulder, or some such. They aren’t all dramatic clutch-the-chest-and-fall-down events. My mom once had a heart attack and didn’t even notice though in her case, post two heart surgeries, it may have been that nerves that otherwise would have alerted her had been severed or otherwise impaired.

Likewise, stroke can manifest as clumsiness or numbness in one limb, or disorientation, or a number of seemingly mild symptoms. Again, it’s not always a dramatic fall-over-half-paralyzed situation.

20

Bleeding ulcer. I had no abdominal pain, but suddenly I felt weak, rubber legs and out of breath. Turns out I had lost half my blood volume, and I thought it was just a bad case of the flu until I started crapping blackberry jam.