A patient died... i don't know if its my fault

[deleted29780]

There was a case of Spinal Muscular Atrophy SMA on my ward last week.
He was type 2 SMA, cos he had normal motor developmental milestones up until about twelve months. This was an interesting case, cos he had two other siblings with the same condition. Both parents are alive and well - it is an autosomal recessive inheritance. Patient is very intelligent and has normal social, language and behavioural development.
The boy presented with cough, hematemesis and chest pain. ( was not pleuritic) On examination, The patient was cachectic, had a scapoid abdomen, and bilateral talipes equinus varus. he was flaring his alae nasi, there was subcostal and intercostal recession ( obviously in respiratory distress, clinically) he was tachypnoeic. On auscultation, breath sounds were bronchial in the lower lobes. bilateral crepitations were heard on the mid and lower zones.

He was admitted, but unfortunately the houseman on call failed to pick up the respiratory infection, cos he reported in the patients notes that the breath sounds were vesicular, no added sounds heard.
The patients respiratory embarrassment was thought to be due to terminal effects of his weak respiratory muscles. i guess.
In my view the patient should have been put on antibiotics, knowing very well that he was a case of SMA-II. Cos these patients usually die from respiratory infections and its complications. There should have been suction, cos the patient was drooling. he should have been placed on a ventilator. He should have been observed closely - assessing blood gas levels. All these were not done.

I feel so down, cos i failed to report my findings on chest examination to a resident or even my consultant. He could still have died, even if antibiotics had been started, cos they usually die from resp infections. But in this case he was not started on immediate antibiotic therapy.
I am disappointed in myself, cos i am part of the team as such i believe its all my fault.

reason for respiratory complications of SMA
1) WEAK RESP MUSCLES. this gives a poor cough reflex, as such patients aspirate secretions and cannot cough out irritants which are inhaled

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[swpm]

Class of 2008 . University of Ghana Medical school

You're a student ... of course it's not your fault. If this guy didn't get a tube, vent, and antibiotics, there were multiple failures at multiple levels.

Students are there to learn. If they happen to contribute to patient care in some way, great. But ultimately, appropriate treatment is the responsibility of the one who signs the chart. If anyone so much as glances at you during the M&M, they're wrong to do so.

 

[Winged Scapula]

As noted above, this is not your fault.

You are there to learn and unfortunately, some of the best learning experiences come from the most tragic. That's not to excuse the situation in which it appears that the child's death was mishandled but that is not your responsibility and you can choose to view this as a tragedy, a medical mismanagement and/or an opportunity to learn from it.

I doubt that you will ever look at another child with SMA the same way again and will never make that mistake when you become a consultant. However, please don't blame yourself for something that happened because of the actions of others.

 

[deleted29780]

As noted above, this is not your fault.
I doubt that you will ever look at another child with SMA the same way again and will never make that mistake when you become a consultant. However, please don't blame yourself for something that happened because of the actions of others.

Point well taken, thank you. i think its the houseman's fault then. Cos he is the only medic who had contact with the patient. I am sure if the patient had been reviewed the next morning, on ward rounds, the signs would have been picked up by the residents or consultants.
In our system, houseofficers have the initial contact with patients. the resident on call reviews the houseofficers diagnosis sometime later that same day. in the mornings, on ward rounds, the consultants are introduced to the patients, then they make a further review. I think in this poor boy's case, the mistake was made at presentation. I have learnt alot from this experience.

 

[deleted87716]

I have learnt alot from this experience.

It's always preferable to learn from the mistakes of others.

 

[ijcMD]

I echo what the other SDNers have said...

and, cos = because, i presume... i guess i'm slow on AIM/MSN lingo these days...