10 million for an 80 year old with cancer? Better have been some egregiously improper care to justify those kind of punitive damages.
Reminds me of newborn pyloromyotomies - routinely emptying the stomach with an NG tube if it’s not already there sounds like a great way to mega-piss patients off.
Seriously. Maybe he died because he was an 80 year old with cancer having multiple operations. I understand that losing a family member is difficult but sometimes you have to figure out when it's time to let go. No one lives forever and the number of moribund patients I see in the hospital with unrealistic families is incredible. And people wonder why our healthcare costs so much with "poor outcomes".
That's where occasionally ventilating with a Supreme while suctioning on the gastric port can save the day. Followed by a therapeutic bronchoscopy to decrease particle load in the lungs. People get hurt more frequently by hypoxia than by aspiration pneumonia.
NPO for elective case? Never. Presumed full-stomach for urgent/emergency? Never (unless NG already in as you said).
Good demo, but just put the suction down the left side to begin with.
Might easily have been the teams fault as well (not necessarily the anesthetist's though, imo). Not enough details in the article. Practicing in another country, I find it frustrating how people here just seem to randomly let go on patients that have any significant chance of doing poorly, especially on the elderly.
Well, the brief days the guy is distended, vomiting, and being operated on for sbo and it states the CRNA didn't preform a rapid sequence induction. If that's true, that's malpractice.
yes, it SAYS that but it also says he waited too long for the sux to take effect. If he used sux then he necessarily must have done an RSI because i can't think of instance when even the stupidest of MD / CRNA would use succinylcholine in a full stomach situation and not push it immediately following the hypnotic. So again, doesn't make sense; unless you were there no way to tell exactly what happened given the info available.
There was a large aspiration in an SBO pt at one of my former jobs (not my case luckily!!!). Pt did indeed die on the table. Couldn't oxygenate... Tough to ventilate. Bronch, etc... Died maybe 1 hr after the event.
The brief also highlights the surgeon as responsible for lack of NG decompression. Surgeons put NGs in virtually everyone, how in the world did it not happen here?
he may have called for help but for regurgitation and aspiration at the point you're calling for help it's probably already too late to avoid the sequelae. i'm not familiar with Dubuque at all but google maps shows this hospital smack in the middle of the city, so like plankton i'm surprised this guy was apparently practicing independently in a non-rural area. just to add a little speculation, it seems like this crna was an old dude and close to retirement so maybe he got complacent with the induction and didn't take the precautions he should have thinking it wouldn't happen to him.
Am I missing something? I read the brief a few days ago but as I remember it was the aspiration that the guy died from. Not a failed airway.
Uncalled for and completely unnecessary.
Shouldn't the NGT be placed before coming to the OR? It can be done in the ed, on the floor or in the icu at anytime. A surgeon or hospitalist isn't even required to place it, it can be done by a nurse.
Yeah. When i do RSI I always document prop, sux, cricoid pressure, tube. Nothing else. Why give ammunition to the lawyers. I never understood the "modified RSI" either. They are an aspiration risk, or they are not. If you do a modified RSI you are acknowledging the aspiration risk, and still not doing a by the book RSI. Lawyers will love this.
Doesn't matter. Aspiration occurs when the patient loses airway protective reflexes (in this case: the induction of GA) this is for the anesthesiologist to recognize and treat. FWIW I don't even think the surgeon should be named at all in this lawsuit. This is a pure anesthesia complication.
NG tube placement is standard of care for small bowel obstruction. This should have been placed pre-operatively. Therefore, the surgeon should be the only one listed on this lawsuit. This is pure surgical malpractice.
I guess it’s different for you guys, being sued is less likely here, but pretty often I have a patient who is at increased risk of aspiration ... but I still don’t do an rsi because for some patients, you should prioritise cvs stability over aspiration risk.
So when deposed as to why NGT was not placed prior to induction of GA your answer would be "well, surgery didn't do it"!!!?
Not in the American system. Airway comes before circulation, unless it's a code. If you think the patient has a serious cardiovascular problem and you need to do RSI, you are supposed to do an awake intubation. There is so much defensive medicine, I am surprised this country needs a military.
Nope. It's anesthesia. While the surgeon should have placed an NGT to decompress the stomach, the patient did not aspirate while on the floor, but during the induction of anesthesia.
Yeah, a lot of the ones I work with, without clear direction, are really casual about RSIs: taping the eyes during induction, giving mask breaths....Nope. It's anesthesia. While the surgeon should have placed an NGT to decompress the stomach, the patient did not aspirate while on the floor, but during the induction of anesthesia.
I had a similar case just last month (SBO). I insisted that we place an NGT while the patient was waiting in the holding area (the surgeon did). That put out 200 ml of bilious fluid. When we took the patient to the OR, dear CRNA wanted to do regular induction (because the stomach was "empty").
When a patient shows up in the holding area they belong to you too.
I don't give mask breaths because modified RSI is BS but what's wrong with taping the eyes? I tape while waiting for the sux to take effect which is just the few seconds i need to protect the eyes; while it's nice to avoid aspiration, i'd like to avoid aspiration AND corneal abrasions when possible.
If you let go of the mask, you lose PEEP and derecruit. Ideally, you should have the pop-off valve at 5-10 or more during pre-oxygenation and induction, and the mask should be held tight on the face until it's time to intubate. Safety first, comfort second.
Not a big deal, just seems to be a weird thing to focus on during an RSI. also, usually the patient's eyes are closed when I'm intubating, tape or not.
Great video above regarding techniques for dealing with emesis during induction!
Not always true. You could tape eyeballs pre induction. Everyone wins
It might be our responsibility to place an Ng pre-op in sbo but it is negligent to the extreme that the surgeons didn't place the Ng first.
1. Eyeballs taped
