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TESTING PITFALLS

#FalseReassurance

 

Q: WHAT IS THE MOST COMMON TYPE OF PITFALL LEADING TO BAD OUTCOMES AND LAWSUITS IN EMERGENCY MEDICINE?

 

A: FALSE NEGATIVE TESTS 

 

BELOW ARE SOME OF THE MOST IMPORTANT ONES TO BE AWARE OF

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A normal troponin CAN rule out an MI >6 hours old. 

It CANNOT rule out a more recent MI or true unstable angina

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A normal ovarian or testicular duplex can rule out a complete torsion

It CANNOT rule out an intermittent or partial torsion

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A normal knee x-ray CAN rule out a most fractures

It CANNOT rule out a spontaneously reduced knee dislocation, arterial injury or minor tibial plateau fracture. 

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A normal CT of the brain CAN rule out a brain bleed. 

It CANNOT rule out an ischemic stroke, especially if it is small or <24 hours old

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A WBC count that is normal CAN rule out leukemia

It CANNOT rule out a severe infection, but if both the differential and WBC morphology are normal, it makes serious infection a lot less likely, so make sure you check for left shift, bands, toxic granules/vacuoles and Dohle bodies

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