In the fast-paced environment of a chiropractic office, recognizing medical emergencies can mean the difference between life and death. This reality became all too clear in a case involving a patient who experienced a stroke following a visit to a chiropractic clinic.
The patient, a middle-aged female, arrived at the clinic complaining of neck pain after a minor trauma the previous week. Following a routine evaluation and cervical adjustment, the patient began exhibiting troubling symptoms, including dizziness, nausea and a pounding headache. While these symptoms might sometimes be dismissed as benign, their sudden onset after an adjustment should have been treated as a serious warning sign.
Instead of recognizing the urgency of the situation, the doctor placed the patient in a different examination room and suggested they rest and hydrate. In addition, the doctor recommended the patient go home and come back the following day for another adjustment.
While the intention may have been to provide comfort, this decision delayed the patient being assessed further in that moment – and time is of the essence with stroke situations. Later that evening, she presented to the ER with symptoms that had not subsided and was diagnosed with a vertebral artery dissection and stroke.
The Malpractice Risk
Fortunately, the patient recovered – but subsequently filed a lawsuit against the chiropractor for malpractice. While the claim of causation was defensible, allegations of negligence and failure to refer were much harder to contest.
This case is a stark reminder that even when causation is not established, defending against negligence claims can be costly, both financially and reputationally.
Understanding Posterior Circulation Stroke (PCS)
This case highlights the unique challenges of diagnosing strokes, particularly posterior circulation strokes (PCS), which result from conditions like vertebral artery dissection (VAD). PCS symptoms often differ from the more widely recognized signs of anterior circulation strokes. While dizziness, imbalance, difficulty speaking, and visual disturbances may signal a posterior stroke, these symptoms can be subtle and nonspecific, even for emergency physicians and neurologists.
Studies indicate that PCS constitutes 20%-25% of all strokes and is more likely to be missed in emergency departments compared to anterior strokes. The common signs of stroke align more closely with anterior strokes, making posterior strokes even more challenging to recognize.
Adding to the complexity, the relationship between trivial trauma and VAD is not fully understood. Hypotheses suggest that while trivial trauma might not cause dissections, it could exacerbate existing conditions or lead to complications like emboli. Chiropractors must approach patients presenting with recent minor trauma and unusual symptoms with heightened caution.
Discussion / Takeaway
I use this scenario to highlight the importance of recognizing and responding appropriately to potential medical emergencies. It is far better to err on the side of caution by sending a patient to urgent care or the ER – even if the outcome turns out to be benign - rather than hoping and expecting the situation will resolve on its own.
Chiropractors are not expected to diagnose strokes, but they have a responsibility to act decisively when faced with symptoms suggesting a serious condition. In the described case, the appropriate course of action would have been to stop all procedures, call 911, and document the incident thoroughly.
The lesson here is clear: You must be vigilant and prepared to act promptly when patients exhibit unusual symptoms. Dizziness, severe headaches, nausea, tingling, weakness, or facial drooping should all be treated as potential warning signs of a stroke.
It also demonstrates the importance of having office procedures in place so you are prepared to navigate emergency situations without skipping a beat. Every member of your team should be trained in how to properly handle emergency situations, ensuring that 911 is called without delay when the situation warrants it. Open communication with patients about the importance of reporting unusual symptoms, recent traumas, etc., can also play a vital role in mitigating risks.
While some adverse events may be unavoidable, the way you respond can significantly impact outcomes and legal standing. Thorough documentation of all incidents, including symptoms observed and actions taken, is critical in protecting yourself if litigation becomes a reality.
By prioritizing patient safety and maintaining readiness to handle emergencies, you can reduce exposure in your practice, uphold professional integrity and build trust with patients. Recognizing and responding to medical emergencies is not just a best practice – it is an essential component of care.
