Are mistakes like this common?

[toughlife]

Family Sues After Woman Dies From Mistake At Military Hospital
Military Takes 12 Days To Send Woman Across Country For Special Treatment

POSTED: 4:12 pm HST May 9, 2005

HONOLULU -- The family of a young Marine's wife, who suffered brain damage and eventually died because of a medical mistake while giving birth at Tripler Army Medical Center, filed a lawsuit Monday against the federal government.

The woman's baby boy is now developmentally disabled.

The family filed suit Monday against the federal government over the woman's injuries and death.

Dec. 14, 2002, was supposed to be the happiest day of Jennifer and Vincent Adams' lives. Jennifer, just 20 years old at the time, was giving birth to the couple's first child. As a result, she was bedridden, unable to speak or walk. She also needed feeding and breathing tubes.

Lance Cpl. Vincent was a Marine stationed at Marine Corps Base Hawaii in Kaneohe. The accident happened after his wife had been in labor for nearly two days at Tripler.

A lawyer shot home video of the Adams in March 2003 at Tripler.

"From there, she requested the epidural because it was a lot of pain. I could tell she was in a lot of pain," Vincent Adams said.

His lawyer said a nurse anesthetist administered the epidural to dull Jennifer's pain and asked her to recite the alphabet backwards. When she stuttered on the letter "S," her husband said he knew there was trouble.

"She looked at me and said that she was scared," Vincent Adams said. "And I was calling her name and she just looked at me and her eyes rolled in the back of her head, and she just fell sideways to the bed. Her whole face just turned blue and her face went down."

His attorney said Jennifer's epidural was administered in the wrong place and anesthetized her heart and diaphragm. She went into cardiac arrest and stopped breathing. Her brain received no oxygen for at least six to eight minutes and she suffered severe brain injury.

Her baby boy was born lifeless and had to be revived.

"I didn't hear the baby crying or anything. So I was pretty… I was scared and at the time, mad at what had happened," Adams said.

His lawyer said the baby, named Diego, who is now 2 years old, suffered a stroke and a seizure six weeks after he was born.

"Has been diagnosed with cerebral palsy, right-sided hemiperisis, which is a partial paralysis, and what's called developmental delay," attorney Will Copulos said.

Tripler didn't have a brain rehabilitation facility, which Jennifer needed, according to Copulos. So, the Army sent her to one in Florida, near her parents.

They arranged for her to go "space available" on military aircraft with her husband and a registered nurse. They left Honolulu on April 2, 2003.

That was just a few weeks after the start of the Iraq war and apparently there wasn't much space available on military aircraft.

The trip took 12 days. They went from Honolulu to California, where she checked into a military hospital for five days as she waited for available planes.

Then she flew from Northern California to San Diego and Glendale, Az., and next to an Air Force base in San Antonio, Texas, where she spent another seven days in a hospital waiting for another plane. Finally, on April 14, she was flown to Ft. Lauderdale, Fla.

Summarized Flight Travel:
April 2 - Depart Honolulu for Travis AFB near Vacaville, Calif.
April 7 - Depart Travis AFB for San Diego; depart San Diego for Luke AFB, Az.
April 14 - Depart Luke AFB for Lackland AFB San Antonio, Texas; Depart Lackland AFB for Ft. Lauderdale, Fla.

"It's the 12 days with a half a dozen landings and takeoffs that we're outraged by," Copulos said.

Jennifer died two days after arriving at her final stop of pneumonia.

Copulos said she should have been flown on a commercial plane with a nurse escort. He said it would have cost about $2,500 and would have taken just a day. He believes if Vincent Adams had been a high-ranking officer that slow trip across the country would never have been allowed.

Vincent Adams now lives with his son in Raleigh, NC, where his mother and brothers also live. Vincent is still in the Marines, working at a reserve-training center there.

While he planned to make a career in the Marines, he's decided to retire because he wants his son to have steady medical treatment without moving every three years.

The lawsuit, filed Monday in federal court, asks for unspecified damages. The family filed a claim in May of last year with the military, but has not heard a response, Copulos said.

"We want to make sure that the family is compensated for what they've been through and for what they're yet to go through," Copulos said.

He said it's unclear how much extra medical treatment Diego will need, because the extent of his developmental problems won't become clear until he is older.

Copulos said this case shows why efforts to limit medical malpractice awards for pain and suffering -- so called "punitive damages" -- would not be fair.

"In this case, any kind of a cap would bring about, in our view, a miscarriage of justice," he said.

Copulos said that's because Jennifer and Vincent Adams were so young, and were deprived of a long life together, and their 2-year-old son will need special care for his entire life.

A spokeswoman for Tripler refused to comment on the specific allegations of this lawsuit. Public Affairs Officer Margaret Tippy said that medical evacuation of patients from Tripler is "based on the medical condition of the patient."

"It has absolutely nothing to do with any kind of rank structure," Tippy said.

In another case, in January of this year, a baby boy was mistakenly given carbon dioxide instead of oxygen just after birth at Tripler. As a result he's in a persistent vegetative state.
Copyright 2005 by TheHawaiiChannel.com All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


http://www.thehawaiichannel.com/news/4469470/detail.html

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[jetproppilot]

Family Sues After Woman Dies From Mistake At Military Hospital
Military Takes 12 Days To Send Woman Across Country For Special Treatment

POSTED: 4:12 pm HST May 9, 2005

HONOLULU -- The family of a young Marine's wife, who suffered brain damage and eventually died because of a medical mistake while giving birth at Tripler Army Medical Center, filed a lawsuit Monday against the federal government.

The woman's baby boy is now developmentally disabled.

The family filed suit Monday against the federal government over the woman's injuries and death.

Dec. 14, 2002, was supposed to be the happiest day of Jennifer and Vincent Adams' lives. Jennifer, just 20 years old at the time, was giving birth to the couple's first child. As a result, she was bedridden, unable to speak or walk. She also needed feeding and breathing tubes.

Lance Cpl. Vincent was a Marine stationed at Marine Corps Base Hawaii in Kaneohe. The accident happened after his wife had been in labor for nearly two days at Tripler.

A lawyer shot home video of the Adams in March 2003 at Tripler.

"From there, she requested the epidural because it was a lot of pain. I could tell she was in a lot of pain," Vincent Adams said.

His lawyer said a nurse anesthetist administered the epidural to dull Jennifer's pain and asked her to recite the alphabet backwards. When she stuttered on the letter "S," her husband said he knew there was trouble.

"She looked at me and said that she was scared," Vincent Adams said. "And I was calling her name and she just looked at me and her eyes rolled in the back of her head, and she just fell sideways to the bed. Her whole face just turned blue and her face went down."

His attorney said Jennifer's epidural was administered in the wrong place and anesthetized her heart and diaphragm. She went into cardiac arrest and stopped breathing. Her brain received no oxygen for at least six to eight minutes and she suffered severe brain injury.

Her baby boy was born lifeless and had to be revived.

"I didn't hear the baby crying or anything. So I was pretty… I was scared and at the time, mad at what had happened," Adams said.

His lawyer said the baby, named Diego, who is now 2 years old, suffered a stroke and a seizure six weeks after he was born.

"Has been diagnosed with cerebral palsy, right-sided hemiperisis, which is a partial paralysis, and what's called developmental delay," attorney Will Copulos said.

Tripler didn't have a brain rehabilitation facility, which Jennifer needed, according to Copulos. So, the Army sent her to one in Florida, near her parents.

They arranged for her to go "space available" on military aircraft with her husband and a registered nurse. They left Honolulu on April 2, 2003.

That was just a few weeks after the start of the Iraq war and apparently there wasn't much space available on military aircraft.

The trip took 12 days. They went from Honolulu to California, where she checked into a military hospital for five days as she waited for available planes.

Then she flew from Northern California to San Diego and Glendale, Az., and next to an Air Force base in San Antonio, Texas, where she spent another seven days in a hospital waiting for another plane. Finally, on April 14, she was flown to Ft. Lauderdale, Fla.

Summarized Flight Travel:
April 2 - Depart Honolulu for Travis AFB near Vacaville, Calif.
April 7 - Depart Travis AFB for San Diego; depart San Diego for Luke AFB, Az.
April 14 - Depart Luke AFB for Lackland AFB San Antonio, Texas; Depart Lackland AFB for Ft. Lauderdale, Fla.

"It's the 12 days with a half a dozen landings and takeoffs that we're outraged by," Copulos said.

Jennifer died two days after arriving at her final stop of pneumonia.

Copulos said she should have been flown on a commercial plane with a nurse escort. He said it would have cost about $2,500 and would have taken just a day. He believes if Vincent Adams had been a high-ranking officer that slow trip across the country would never have been allowed.

Vincent Adams now lives with his son in Raleigh, NC, where his mother and brothers also live. Vincent is still in the Marines, working at a reserve-training center there.

While he planned to make a career in the Marines, he's decided to retire because he wants his son to have steady medical treatment without moving every three years.

The lawsuit, filed Monday in federal court, asks for unspecified damages. The family filed a claim in May of last year with the military, but has not heard a response, Copulos said.

"We want to make sure that the family is compensated for what they've been through and for what they're yet to go through," Copulos said.

He said it's unclear how much extra medical treatment Diego will need, because the extent of his developmental problems won't become clear until he is older.

Copulos said this case shows why efforts to limit medical malpractice awards for pain and suffering -- so called "punitive damages" -- would not be fair.

"In this case, any kind of a cap would bring about, in our view, a miscarriage of justice," he said.

Copulos said that's because Jennifer and Vincent Adams were so young, and were deprived of a long life together, and their 2-year-old son will need special care for his entire life.

A spokeswoman for Tripler refused to comment on the specific allegations of this lawsuit. Public Affairs Officer Margaret Tippy said that medical evacuation of patients from Tripler is "based on the medical condition of the patient."

"It has absolutely nothing to do with any kind of rank structure," Tippy said.

In another case, in January of this year, a baby boy was mistakenly given carbon dioxide instead of oxygen just after birth at Tripler. As a result he's in a persistent vegetative state.
Copyright 2005 by TheHawaiiChannel.com All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


http://www.thehawaiichannel.com/news/4469470/detail.html

If this was common, I'd be flying airplanes for a living instead of doing anesthesia.

Sounds like an intravascular injection of bupivicaine with resultant catastrophic myocardial toxicity. Certainly speaks for the 3-5 mL push and wait 15-20 seconds method.
Doesnt sound like a high level since those go away after a while. Worse case scenerio is you have to manage the airway for a while and give vasopressors.
Man, I like my ropivicaine combined-spinal epidurals more than ever after reading this. Thanks for the post, although highlighting that it was a nurse anesthetist is probably a little much. Could happen to anyone pushing bupivicaine through a catheter.

 

[doc05]

the delay in getting to the brain rehab facility seems like a non-issue though.

 

[toughlife]

the delay in getting to the brain rehab facility seems like a non-issue though.

I agree. The damage was already done.

 

[dbiddy808]

This is why the place is known as Cripler (not Tripler) in Hawaii. Scary place!

 

[UTSouthwestern]

If this was common, I'd be flying airplanes for a living instead of doing anesthesia.

Sounds like an intravascular injection of bupivicaine with resultant catastrophic myocardial toxicity. Certainly speaks for the 3-5 mL push and wait 15-20 seconds method.
Doesnt sound like a high level since those go away after a while. Worse case scenerio is you have to manage the airway for a while and give vasopressors.
Man, I like my ropivicaine combined-spinal epidurals more than ever after reading this. Thanks for the post, although highlighting that it was a nurse anesthetist is probably a little much. Could happen to anyone pushing bupivicaine through a catheter.

Makes me wonder if that person aspirated the catheter before injecting and at every 2 cc's. Having seen high epidurals, I agree with you Jet that it was likely an IV injection although it could also have been an intrathecal injection, high spinal, and subsequent seizure, severe hypotension, and thus markedly decreased perfusion pressures leading to cardiorespiratory failure and anoxia.

Can happen to anyone but I wonder what type of rescue was attempted and how quickly the situation was recognized and rescue instituted.

 

[jetproppilot]

Makes me wonder if that person aspirated the catheter before injecting and at every 2 cc's. Having seen high epidurals, I agree with you Jet that it was likely an IV injection although it could also have been an intrathecal injection, high spinal, and subsequent seizure, severe hypotension, and thus markedly decreased perfusion pressures leading to cardiorespiratory failure and anoxia.

Can happen to anyone but I wonder what type of rescue was attempted and how quickly the situation was recognized and rescue instituted.

Yeah, certainly could've been intrathecal UT, if the operator was using, say, .25% bupiv and just slammed in about 12-14mL, or worse yet, dosed through the needle. Who knows, but even with a really high level it is a salvagable situation, where bupivicaine myocardial toxicity may not be, despite one's best efforts.

 

[UTSouthwestern]

Yeah, certainly could've been intrathecal UT, if the operator was using, say, .25% bupiv and just slammed in about 12-14mL, or worse yet, dosed through the needle. Who knows, but even with a really high level it is a salvagable situation, where bupivicaine myocardial toxicity may not be, despite one's best efforts.

Dude, go to sleep!

Salvageable if the provider recognized it and had the tools of the trade available, namely blade, tube, O2, Epi, etc. Hypotension should be treated with IV fluids, Trendelenburg positioning, and vasopressors if needed. Bradyarrhythmias can be treated with atropine. Convulsions are generally responsive to diazapam, lorazepam, or midazolam. A prolonged QRS complex may be reversed by sodium bicarbonate.

Unfortunately, hemodialysis, hemoperfusion, and multidose activated charcoal are not effective in lidocaine or bupivicane toxicity. Also, unfortunately, bretylium is the preferred ventricular antiarrhythmic.

 

[Tenesma]

steps that most well-trained anesthesiology providers would have taken
1) intubate
2) oxygenate
3) ventilate
4) hemodynamic support

that fact that she was anoxic for only 8 minutes speaks to the fact that this was probably a high-spinal and not cardiac toxicity (cause those are a bitch - and she probably wouldn't have survived)

5) go on to percutaneous bypass in the Cardiac OR (if it is intravascular bupi)
6) make comments about how Bretylium would have been nice... but there was no money in selling it, so they stopped production... sigh

 

[militarymd]

Hard to imagine bupivicaine toxicity at 25 mg iv??? (10 cc of 0.25 %)

I've seen bupivicaine toxcity manifest in pediatrics (caudal...I posted that), and in adults after large volume blocks...usually just short seizures that self terminate rather than refractory cardiac arrest as seen in the days of 0.75 % at 20cc.

 

[Idiopathic]

In another case, in January of this year, a baby boy was mistakenly given carbon dioxide instead of oxygen just after birth at Tripler. As a result he's in a persistent vegetative state.[/url]

I think this gets me more than the story about the woman.

 

[militarymd]

The news story don't give a lot of medical details. I read the account again, and I still have a hard time believing that "anesthesia" caused that.

From the description, any number of things could have occurred which everyone blames on anesthesia.

I have personally called to assist in/resuscitate 4 amniotic fluid embolisms during my career in the military. 3 died, 1 survived without significant sequlae. The news story description could easily have been some kind of embolism rather than a epidural related complication.

My last duty station (5 years tenure) delivered 300 to 400 babies a month with about 90% epidural rate. Most of which are placed by CA1s and SRNAs frequently with supervision defined as "on L&D" ward....especially at night..if you get my drift. No epidural complications like that in the story, but we did have 3 AFE that sounded just like that.

My 4th was at another teaching hospital.

 

[Tenesma]

AFE could be a possibility - the thing is that the baby should have been delivered by crash c-section right away if initial resuscitation wasn't going anywhere...

 

[jetproppilot]

Dude, go to sleep!

Salvageable if the provider recognized it and had the tools of the trade available, namely blade, tube, O2, Epi, etc. Hypotension should be treated with IV fluids, Trendelenburg positioning, and vasopressors if needed. Bradyarrhythmias can be treated with atropine. Convulsions are generally responsive to diazapam, lorazepam, or midazolam. A prolonged QRS complex may be reversed by sodium bicarbonate.

Unfortunately, hemodialysis, hemoperfusion, and multidose activated charcoal are not effective in lidocaine or bupivicane toxicity. Also, unfortunately, bretylium is the preferred ventricular antiarrhythmic.

Yeah, you just said the same thing I did, except you elaborated. Standard of care dictates that clinicians are prepared for high levels- squirt the local anesthetic in, lady goes capputt, now its your job to initiate all the stuff you listed. Hence, my comment that this situation is salvagable. Don't have access to all the stuff UT listed? Then you're practicing below the standard of care; get ready to write a big malpractice check when things go awry.

With LA myocardial toxicity from bupiv, you may well operate within the standard of care, doing all the same stuff you listed. The problem is that it may or may not work, where in high spinals it is most likely to work.

Comprendez amigo?

We're saying the same thing. You just explained it alot more.

 

[Buckeyedoc]

Family Sues After Woman Dies From Mistake At Military Hospital
Military Takes 12 Days To Send Woman Across Country For Special Treatment

POSTED: 4:12 pm HST May 9, 2005

HONOLULU -- The family of a young Marine's wife, who suffered brain damage and eventually died because of a medical mistake while giving birth at Tripler Army Medical Center, filed a lawsuit Monday against the federal government.

The woman's baby boy is now developmentally disabled.

The family filed suit Monday against the federal government over the woman's injuries and death.

Dec. 14, 2002, was supposed to be the happiest day of Jennifer and Vincent Adams' lives. Jennifer, just 20 years old at the time, was giving birth to the couple's first child. As a result, she was bedridden, unable to speak or walk. She also needed feeding and breathing tubes.

Lance Cpl. Vincent was a Marine stationed at Marine Corps Base Hawaii in Kaneohe. The accident happened after his wife had been in labor for nearly two days at Tripler.

A lawyer shot home video of the Adams in March 2003 at Tripler.

"From there, she requested the epidural because it was a lot of pain. I could tell she was in a lot of pain," Vincent Adams said.

His lawyer said a nurse anesthetist administered the epidural to dull Jennifer's pain and asked her to recite the alphabet backwards. When she stuttered on the letter "S," her husband said he knew there was trouble.

"She looked at me and said that she was scared," Vincent Adams said. "And I was calling her name and she just looked at me and her eyes rolled in the back of her head, and she just fell sideways to the bed. Her whole face just turned blue and her face went down."

His attorney said Jennifer's epidural was administered in the wrong place and anesthetized her heart and diaphragm. She went into cardiac arrest and stopped breathing. Her brain received no oxygen for at least six to eight minutes and she suffered severe brain injury.

Her baby boy was born lifeless and had to be revived.

"I didn't hear the baby crying or anything. So I was pretty… I was scared and at the time, mad at what had happened," Adams said.

His lawyer said the baby, named Diego, who is now 2 years old, suffered a stroke and a seizure six weeks after he was born.

"Has been diagnosed with cerebral palsy, right-sided hemiperisis, which is a partial paralysis, and what's called developmental delay," attorney Will Copulos said.

Tripler didn't have a brain rehabilitation facility, which Jennifer needed, according to Copulos. So, the Army sent her to one in Florida, near her parents.

They arranged for her to go "space available" on military aircraft with her husband and a registered nurse. They left Honolulu on April 2, 2003.

That was just a few weeks after the start of the Iraq war and apparently there wasn't much space available on military aircraft.

The trip took 12 days. They went from Honolulu to California, where she checked into a military hospital for five days as she waited for available planes.

Then she flew from Northern California to San Diego and Glendale, Az., and next to an Air Force base in San Antonio, Texas, where she spent another seven days in a hospital waiting for another plane. Finally, on April 14, she was flown to Ft. Lauderdale, Fla.

Summarized Flight Travel:
April 2 - Depart Honolulu for Travis AFB near Vacaville, Calif.
April 7 - Depart Travis AFB for San Diego; depart San Diego for Luke AFB, Az.
April 14 - Depart Luke AFB for Lackland AFB San Antonio, Texas; Depart Lackland AFB for Ft. Lauderdale, Fla.

"It's the 12 days with a half a dozen landings and takeoffs that we're outraged by," Copulos said.

Jennifer died two days after arriving at her final stop of pneumonia.

Copulos said she should have been flown on a commercial plane with a nurse escort. He said it would have cost about $2,500 and would have taken just a day. He believes if Vincent Adams had been a high-ranking officer that slow trip across the country would never have been allowed.

Vincent Adams now lives with his son in Raleigh, NC, where his mother and brothers also live. Vincent is still in the Marines, working at a reserve-training center there.

While he planned to make a career in the Marines, he's decided to retire because he wants his son to have steady medical treatment without moving every three years.

The lawsuit, filed Monday in federal court, asks for unspecified damages. The family filed a claim in May of last year with the military, but has not heard a response, Copulos said.

"We want to make sure that the family is compensated for what they've been through and for what they're yet to go through," Copulos said.

He said it's unclear how much extra medical treatment Diego will need, because the extent of his developmental problems won't become clear until he is older.

Copulos said this case shows why efforts to limit medical malpractice awards for pain and suffering -- so called "punitive damages" -- would not be fair.

"In this case, any kind of a cap would bring about, in our view, a miscarriage of justice," he said.

Copulos said that's because Jennifer and Vincent Adams were so young, and were deprived of a long life together, and their 2-year-old son will need special care for his entire life.

A spokeswoman for Tripler refused to comment on the specific allegations of this lawsuit. Public Affairs Officer Margaret Tippy said that medical evacuation of patients from Tripler is "based on the medical condition of the patient."

"It has absolutely nothing to do with any kind of rank structure," Tippy said.

In another case, in January of this year, a baby boy was mistakenly given carbon dioxide instead of oxygen just after birth at Tripler. As a result he's in a persistent vegetative state.
Copyright 2005 by TheHawaiiChannel.com All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


http://www.thehawaiichannel.com/news/4469470/detail.html

What may I ask is any L&D unit / OBGYN doing allowing a woman to be in labor for 2 DAYS? Why was she not sectioned as the delivery clearly arrested????
Secondly, how could a pt be anoxic for 8 MINUTES (!!!!) in the presence of ANY trained anesthesia professional??? Where the hell was the anesthesiologist? (if you say the lounge I will quit this profession right now)

 

[Tenesma]

being in labor for 2 days is NOT rare... most OB/GYNs do get impatient though and will usually use any hint of trouble/delay as a reason to accelerate labor or delivery via c-section

even with the most competent anesthesiologist in the world it is possible to be anoxic for 8 minutes.... if you are unable to provide blood flow to the brain (due to a fibrillating heart and very difficult cardiac compressions due to a pregnant belly etc...), then 100% oxygen still doesn't help 🙁

 

[Buckeyedoc]

being in labor for 2 days is NOT rare... most OB/GYNs do get impatient though and will usually use any hint of trouble/delay as a reason to accelerate labor or delivery via c-section

even with the most competent anesthesiologist in the world it is possible to be anoxic for 8 minutes.... if you are unable to provide blood flow to the brain (due to a fibrillating heart and very difficult cardiac compressions due to a pregnant belly etc...), then 100% oxygen still doesn't help 🙁

I just do not see it, logistically speaking. All I can speak for is the experience from hospital where I am training. The L&D nurse hit the code button on the wall.... starts compressions after the CRNA should have established pulselessness, and the CRNA should have been bagging from the get go while respiratory / other L&D nurses get the crash cart. Most LD units have the OR nearby, and therefore it should not have been a matter or lack of resources. It minutes in a code goes by like years, so something stinks in wonderland here about this story.
Just my opinion........ no argument necessary

 

[Buckeyedoc]

I just do not see it, logistically speaking. All I can speak for is the experience from hospital where I am training. The L&D nurse hit the code button on the wall.... starts compressions after the CRNA should have established pulselessness, and the CRNA should have been bagging from the get go while respiratory / other L&D nurses get the crash cart. Most LD units have the OR nearby, and therefore it should not have been a matter or lack of resources. It minutes in a code goes by like years, so something stinks in wonderland here about this story.
Just my opinion........ no argument necessary

That should have read "8 minutes in a code..."

My typing stinks today

 

[toughlife]

Where the hell was the anesthesiologist? (if you say the lounge I will quit this profession right now)[/QUOTE]


They want the independence, so let them deal with the problems themselves. Why get mad at the MDA?

 

[jem04]

The news story don't give a lot of medical details. I read the account again, and I still have a hard time believing that "anesthesia" caused that.

From the description, any number of things could have occurred which everyone blames on anesthesia.

I have personally called to assist in/resuscitate 4 amniotic fluid embolisms during my career in the military. 3 died, 1 survived without significant sequlae. The news story description could easily have been some kind of embolism rather than a epidural related complication.

My last duty station (5 years tenure) delivered 300 to 400 babies a month with about 90% epidural rate. Most of which are placed by CA1s and SRNAs frequently with supervision defined as "on L&D" ward....especially at night..if you get my drift. No epidural complications like that in the story, but we did have 3 AFE that sounded just like that.

My 4th was at another teaching hospital.

A friend of mine was in the room for an epidural when the patient had a similar event (abrupt unconsciousness progressing to cardiac arrest) - everyone rushing in immediately wanted to blame the epidural - luckily he had not even finished prepping when it happened. I believe that AFE was the (post-mortem) diagnosis (I don't remember all the details).

 

[rn29306]

His lawyer said a nurse anesthetist administered the epidural to dull Jennifer's pain and asked her to recite the alphabet backwards. When she stuttered on the letter "S," her husband said he knew there was trouble.

Hey toughlife, thanks for the bold printing emphasizing just who gave the epidural. You weren't there and neither were the laywers involved. Yes, I agree that 8 minutes of lack of oxygen certainly reveals some form of deficiency - but you certainly don't know all the facts and newspaper reporting hasn't been exactly known to reveal all the truths / facts.

At what point are you in your insecure education that you are pointing fingers at anyone?? I assume that you have never made an error, have never had a resident or attending correct your erroneous orders or actually had an incorrect order come to fruition. I'm betting a lowly nurse has even bailed out your sorry short coat at some point. If you have completed an OB rotation, then perhaps you realize what a small space the epidural area is, how wet taps occur to circumstances outside your control, how the various phys changes in mothers decrease this space and potentiate intravascular placement, that errors do occur, medicine and anesthesia are certainly not infallible AND NEITHER ARE YOU.

Thanks for the cheap shot bro.

 

[militarymd]

As I have been saying, I'm having trouble believing that this is even anesthesia/epidural related.

As for the "8 minutes of hypoxia", after an embolic even (especially something like aminotic fluid....or clot), proper tube placement and ventilation with 100% percent oxygen is not going to reverse or prevent hypoxia.

The news story does not give enough information....No one knows what happened, but I do know that the military has EXCELLENT CRNA's, in general, and they do know how to ventilate.

 

[jetproppilot]

As I have been saying, I'm having trouble believing that this is even anesthesia/epidural related.

As for the "8 minutes of hypoxia", after an embolic even (especially something like aminotic fluid....or clot), proper tube placement and ventilation with 100% percent oxygen is not going to reverse or prevent hypoxia.

The news story does not give enough information....No one knows what happened, but I do know that the military has EXCELLENT CRNA's, in general, and they do know how to ventilate.

Yeah you're right military. All we can do is speculate, but its kinda fun to see everyones opinion.
But if dudes puttin' in the epidural and she keels over at the same time he's puttin in the epidural, chances are its from the epidural. Sure, it could be something else, but if it looks like a duck, smells like a duck, and swims like a duck, Dude, its a duck. Yeah, we could play internal medicine stud and rule out 150 other potential diagnoses, but I'm going with the top 2- she either had an intravascular or intrathecal injection until proven otherwise. Maybe the report isnt reporting the subsequent events right. Who knows.

 

[militarymd]

but if it looks like a duck, smells like a duck, and swims like a duck, Dude, its a duck.

Jet,

But my point is, it doesn't smell like anything.

The news story gives little detail as to the timing of events. The only reason folks are assuming it is the epidural is because the LAWYER in the news article says it was the epidural. I've been a specialty reviewer for 3 cases in the military, and from experience, I know that lawyers will say anything....and I mean anything.

The article mentions that the father didn't hear his baby crying after the delivery....was he in the room for the crash C-Section that I'm sure happened?....or did the OBs let an unconscious hypoxic woman labor on for a vaginal delivery with the father in attendance.....

Assuming reasonable peri-partum care that is delivered in the 21st century:
- OB in attendance...crash c-section after event
- 10cc 0.25% marcaine as loading dose for CLE..meaning at most 25 mg IV of marcaine.....very unlikely to cause the event
- In the unlikly event that CV collapse occurred from the marcaine, there should not have been prolonged hypoxia because trained anesthesia providers would immediately intubate and start resuscitation while c-section is performed....unlikely that father would be allowed to stay in attendance


The above is assuming reasonable care, and I have no reason to believe that the military does not provide that.

My opinion is that the news story has sensationalized the event, and we don't know what happened.

 

[militarymd]

I'm currently a witness in a case where the plaintive's lawyer is claiming a wrong dose of narcotic led to a death in the ICU.

The lawyers claim that an order for fentanyl PCA dose was written as "50 mg" vs the correct " 50 mcg"

I explained how this is physically impossible. I know of no PCA pump that is capable of delivering one liter PCA doses......but the lawyers persist.

They WILL say anything.

I explained that the patient will likely die from volume overload from the PCA does

 

[Tenesma]

militarymd... i am with you on this one. Could it be Marcaine - sure... Could it be an AFE - sure.... Lawyers will say anything - and it is a lot easier to make money off an "epidural" issue than an AFE!

Buckeye... it might be hard to understand, but once you have coded a few people you will understand that just because there is an endotracheal tube with O2 running through it, it doesn't mean the brain is going to get any of it....

what i find bizarre about the story is why the nurse anesthetist was having the patient do the alphabet backwards while doing an epidural??? who does that? and why would you do that? that is the fishiest part of all of this...

 

[toughlife]

Hey toughlife, thanks for the bold printing emphasizing just who gave the epidural. You weren't there and neither were the laywers involved. Yes, I agree that 8 minutes of lack of oxygen certainly reveals some form of deficiency - but you certainly don't know all the facts and newspaper reporting hasn't been exactly known to reveal all the truths / facts.

At what point are you in your insecure education that you are pointing fingers at anyone?? I assume that you have never made an error, have never had a resident or attending correct your erroneous orders or actually had an incorrect order come to fruition. I'm betting a lowly nurse has even bailed out your sorry short coat at some point. If you have completed an OB rotation, then perhaps you realize what a small space the epidural area is, how wet taps occur to circumstances outside your control, how the various phys changes in mothers decrease this space and potentiate intravascular placement, that errors do occur, medicine and anesthesia are certainly not infallible AND NEITHER ARE YOU.

Thanks for the cheap shot bro.

I am sure if it would have been an MDA, you would have come in here stating CRNAs are "safer" than anesthesiologists. So now you are mad because one of you dropped the ball.

 

[Tenesma]

toughlife - i suggest you delete your post ASAP and apologize.... that is incredibly crude and rude - unbecoming of a gentleman.

 

[toughlife]

toughlife - i suggest you delete your post ASAP and apologize.... that is incredibly crude and rude - unbecoming of a gentleman.

OK I was aggressive there. I corrected it.

 

[Tenesma]

thanks... didn't want to see you banned 🙂

 

[Idiopathic]

I'm currently a witness in a case where the plaintive's lawyer is claiming a wrong dose of narcotic led to a death in the ICU.

The lawyers claim that an order for fentanyl PCA dose was written as "50 mg" vs the correct " 50 mcg"

I explained how this is physically impossible. I know of no PCA pump that is capable of delivering one liter PCA doses......but the lawyers persist.

They WILL say anything.

I explained that the patient will likely die from volume overload from the PCA does

This reminds me of a Scrubs episode:

"Dr. Cox, one of the interns just wrote for 500,000 grams of morphine"

Could you imagne 50 mg of fentanyl? Now, if the px actually got 50 mg, Id say the lawyer had a pretty good case...probably didnt go down like that tho.

 

[Justin4563]

that case is a high spinal

the catheter was t hreaded into the intrathecal space and it was injected with whatever marcaine lidocaine.. thinking it was in the epidural space.. and epiduaral dosing is like 10 times larger thatn spinal dosing.. so there you have it.. TOTAL SPINAL.. Brainstem anesthesia.. apnea.. bradycardia.... badness..

Its not a bad thing that happens.. its bad if you dont recognize it.. you have to act fast with those high spinals.. her ventilation should have been controlled and circulation supported immediately... and she should have been taken to cesarian section. The details of the case were omitted though. thats why you have to be ultra ultra careful with those epidurals.. DONT **** AROUND WITH THEM

 

[Justin4563]

that case is a high spinal

the catheter was t hreaded into the intrathecal space and it was injected with whatever marcaine lidocaine.. thinking it was in the epidural space.. and epiduaral dosing is like 10 times larger thatn spinal dosing.. so there you have it.. TOTAL SPINAL.. Brainstem anesthesia.. apnea.. bradycardia.... badness..

Its not a bad thing that happens.. its bad if you dont recognize it.. you have to act fast with those high spinals.. her ventilation should have been controlled and circulation supported immediately... and she should have been taken to cesarian section. The details of the case were omitted though. thats why you have to be ultra ultra careful with those epidurals.. DONT **** AROUND WITH THEM