25 yo male patient comes into the ER. He is mentally disabled from a previous brain trauma and has been residing in a residential care home. Orientation to person/place/thing = good, was alert and communicated rather well. Can respond to basic questions with proper relevency. No change in mental status. He was brought into the ER from the nursing home who reported that he had been running a 103 fever and had a cough/congestion. He was admitted for Pneumonia. As per nursing home staff, there was a common cough/cold going around the home where patient was living and it was believed that this was simply an exacerbation of the virus. CBC normal, chest xray normal and basal temperature upon admission was normal and not elevated. He was admitted and put on antibiotics. As per the Nursing Home staff, the patient had a very good diet, was eating well but was being fed a "ground food" diet in the home as he had some dysphagia. Orders were written to continue a regular ground food diet. Nursing home did not report any changes or worsening of the dysphagia symptoms or any related difficulties. H&P also aluded to some history of seizure disorder but nursing home stated that he hadn't had a seizure in a long time. His regular szr meds were continued.

Patient coded and died...

At the time of intebation, there was what looked to be some pieces of food in the airway. Perhaps he choked on his food?

Can we have a discussion on this patient?

What's your agenda on this?

What's your agenda on this?

maybe his family of the victim looking for a possible lawsuit against the ER people and hospital.

maybe his family of the victim looking for a possible lawsuit against the ER people and hospital.

i'll second the nomination.

Especially since he spelled intubation wrong.

Finally, someone with less posts than me!

Hence my question.

Sorry to hear about your loss Doino.

I used the quote in your signature in a presentation about gastric bypass surgery last year.

Any more info besides "he coded and died"? You seem to be implying that this is some how related to the fact that he wasn't continued on his sz meds....

I have the same question. You need to elaborate on "coded and died." Did he have something like a fatal arrythmia or did he develop respiratory failure?

There are SO MANY different things that could have happened to this patient that it would be very hard to discuss this case logically without knowing more about the patient's hospital course.

Your limited history suggests that an infection was suspected, but there was no elevated wbc and you say he was afebrile and the xray was normal. Was he in any respiratory distress upon arrival to the ER? Did he have any abnormal lab results? Doesn't sound like he was septic.

Antibiotics given for pneumonia generally don't make patients code and die unless the patient has a severe allergy to the antibiotic, in which case the physician is not expected to magically know about the allergy unless someone conveys a history of allergies.

As far as food in the airway, even if there was huge chunk of food in a main stem bronchus causing one whole lung to collapse, most people would have acute respiratory distress but it would not cause rapid death. If there was food obstructing the trachea, that could be a problem, but a patient with that would have respiratory distress at the time of arrival to the ER.

Don't feed the troll.
Q

or he intubated the wrong 'way'...probably he missed the trachea and just pushed in the endotracheal tube into the oesophagus. Then when he presses the air bag... he would have pumped the stomach, which in turn causes regurgitation of food either from the stomach or lower oesophagus. Seen that happen ! ..not a good sight.