Misread Chest X-Ray of The Patient Led to Respiratory Failure and Death

NARRATOR: A 25-year-old female patient visits primary hospital for check-up, she
complained for headache, runny nose, cough and sore throat. She was diagnosed by
his primary care clinician with sinusitis and prescribed an antibiotic. After 6 days she
was evaluated in an urgent care clinic due to fast heart rate, labored breathing, extreme
fatigue, and chest pain with cough.

Nurse: Doctor Galleno, patient X body temperature elevated to 38.2°C, she also
complains of difficulty of breathing and has low oxygen saturation.

Doctor: Give 2.5 milligrams of Albuterol via nebulizer 3 or 4 times per day as needed.

Nurse: I'll administer the medicine right away Doc.

Doctor: And prepare the patient for Chest X-ray Examination.

Nurse: Yes Doctor, thank you.

Narrator: After the administration of the medication, the patient's oxygen saturation
improved. The nurse accompanied the patient to the X-Ray room as ordered by the
physician.

Nurse: Good morning ma'am, Doc. Galleno ordered a chest x-ray for patient X.

Radiologist: Ok, our schedule is clear as of the moment, we can conduct the procedure
now.

Nurse: That's good. I'll will take my leave now I'll just come back after 30mins.

Radiologist: Ma'am, if you may please remove your brassiere and any type of jewelry in
that comfort room?

Patient: Excuse me ma'am, but where can I put my things?

Radiologist: You can put them on the table ma'am. Ok ma'am can you please go behind
the x-ray machine and place your front flat on the surface ma'am

Patient: Are we done?

Radiologist: And we're done, thank you for your cooperation ma'am. You can dress up
now in the cr.

Patient: When can I get the result?

Radiologist: you can comeback after two days ma'am for the result of your x-ray.
Narrator: After 2 days the patient came back to the hospital.

Patient: Good morning Doc. Can I have the result?

Radiologist: Ma’am based on the x-ray result you are diagnosed with upper respiratory
infection and you’ll need to go to your doctor for immediate intervention.

Patient. Thank you, Doc.

Narrator: The patient goes to her doctor immediately and the doctor check the result
without checking properly and agreed to the Radiologist’s medical diagnosis.

DOCTOR: So, ma’am base on the reading of the Radiologist you have URTI you need
antibiotics for infection and acetaminophen for fever and pain and you can go home
now.

NARRATOR: The doctor gives the medication and advice the patient to increase fluid
intake and take a rest.

PATIENT: Thank you Doc.

NARRATOR: After 2 days the patients feel a sharp or stabbing chest pain that gets
worse when you breathe deeply and cough which produce greenish, or even bloody
mucus. The patient also having loss of appetite, low energy and fatigue. The family
traveled to the nearest hospital different from the previous one but before she could get
to the emergency department, the patient died of respiratory failure associated with
pneumonia.