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Cheerleader's parents sue for MH DEATH
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"Statistically, 95 percent of people that get malignant hyperthermia live," Zappitell said. "Five percent die and that's typically due to physician error."
I think we should be able to sue lawyers if they make an "error" while representing their client. Didn't provide sufficient counsel defending me on that lawsuit? You owe me for damages. Someone gets wrongfully imprisoned? The lawyer should serve the term as well. Maybe then they will begin to understand that even in a well-prepared scenario when you try to do everything right, things will go wrong.
I think we should be able to sue lawyers if they make an "error" while representing their client. Didn't provide sufficient counsel defending me on that lawsuit? You owe me for damages. Someone gets wrongfully imprisoned? The lawyer should serve the term as well. Maybe then they will begin to understand that even in a well-prepared scenario when you try to do everything right, things will go wrong.
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This was all over the news when it happened, and unfortunately, was a lesson in how things should NOT be done.
General anesthesia should be banned from use in outpatient surgery centers, Thomas Kuleba said.
maybe all outpatient surgery centers should be closed altogether?
He also warned patients to know their anesthesiologist before surgery rather than meeting them for the first time while getting prepped for surgery.
Well, that warning has to be directed toward their surgeons and themselves - nobody wants to come to anesthesia preop clinic anyway...
maybe all outpatient surgery centers should be closed altogether?
He also warned patients to know their anesthesiologist before surgery rather than meeting them for the first time while getting prepped for surgery.
Well, that warning has to be directed toward their surgeons and themselves - nobody wants to come to anesthesia preop clinic anyway...
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"The evidence will show that they used one to two vials of dantrolene"
If true, open up the vault, give them a wheel barrow, and tell em to fill er up.
"the drug dantrolene, which cools the body from the inside."
Oh, it works like an ice water lavage. Lawyers teach me new medicine every day.
If true, open up the vault, give them a wheel barrow, and tell em to fill er up.
"the drug dantrolene, which cools the body from the inside."
Oh, it works like an ice water lavage. Lawyers teach me new medicine every day.
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But he'd be OK with sedation that borders on the edge of GA or the use of potentially cardiotoxic doses of LA in an outpatient setting?
Because he's obviously well qualified to make that decision. 🙄
And the surgeons are always trying to get out of sending their patients to clinic. We had a big interdepartmental fuss when the plastics guys wanted to send their "healthy" (by their definition) patients directly to day of surgery admission (do not pass the anaesthetists, do not collect an airway assessment). Ultimately the surgeons were told that they could do this provided they accepted that there would be delays in starting and continuing the lists (whilst the anaesthetist conducted a full pre op assessment rather than an abbreviated one based on the clinic assessment) and they accepted that there would be cancellations of patients who did not have adequate preoperative investigations available or were otherwise not suitable to proceed with an elective anaesthetic.
Funnily enough the patients started coming through clinic again after a month or so.
I think part of the problem with patients agreeing to have surgery in settings that don't have the same facilities as they ultimately decide they would have liked to have had (with 20/20 hindsight) and with their lack of interest in coming to preop clinics lies in the lack of understanding that the general public (and many parts of the healthcare and medical professions) have regarding the risks of anaesthesia. Have we gotten too good at presenting (on a population level) the concept that anaesthesia is safe? How do we make people who have a very poor understanding of the concept of risk understand that an anaesthetic related mortality of ~1:53000* is more than nothing? Without making them so scared that people refuse to have their laparotomy for SBO?
*Reference (just to keep people like Blade happy) Safety of Anaesthesia: A review of anaesthesia related mortality reportings in Australia and New Zealand 2003-2005; Australian and New Zealand College of Anaesthetists, 2009
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Definitely! This guy, for example, really needs to be sued by his client. And probably kicked off the bar. He should also be banned from further use of the English language.
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Loved the red pencil for edits!
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About the MH case... inexcusable. Two vials is 40mg of dantrolene. The starting dose is 1mg/kg, and I highly doubt this girl was 40 kilos.
You need invasive monitoring (at least an art line) and a Foley.
You need to be in an ICU posthaste.
Delaying any call for help, once you suspect MH, creates a situation where you're more likely to have a really bad outcome.
This was inexcusable.
The solution? All truly outpatient procedures done in doctor's offices should be done with TIVA and non-triggering agents.
-copro
You need invasive monitoring (at least an art line) and a Foley.
You need to be in an ICU posthaste.
Delaying any call for help, once you suspect MH, creates a situation where you're more likely to have a really bad outcome.
This was inexcusable.
The solution? All truly outpatient procedures done in doctor's offices should be done with TIVA and non-triggering agents.
-copro
All outpatient procedures should be done WHEREever the patient wants it done. They are the ones paying for it. They are the ones assuming the risk. The answer is not more regulation. This was a highly freak accident. More women die from fat emboli during lipo in 1 year than 10 years of MH... BY FAR. Surgery has risks. This little girl assumed the risks and unfortunately the help she got in an emergency was too little, too late. She assumed the risks. She's dead now. Sueing the doctor won't change a thing.
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So patients should have a complete understanding of everything involved in their anaesthesia and they should be able to dictate to you how they want their anaesthetic given?
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If they really did give only 40mg, then I agree with you (I do wonder if we have the full story though).
Not sure where you get 1mg/kg from though - it should be 2.5mg/kg starting dose.
Our guidelines suggest that any site anaesthetising using MH triggering agents should have a minimum of 24 vials of dantrolene on site.
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Try going back and find out what actually happened here.
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No, but if you're going to do general anesthesia, you damn well better be fully prepared to handle the complications. The surgery centers I have worked at all have enough dantrolene on hand for initial treatment, and have cooperative arrangements with nearby surgery centers and hospitals to quickly obtain more if needed. They also have arrangements for quick transfers to hospitals. Having dantrolene in adequate amounts is simply a cost of doing business, just like having anesthesia machines, surgical staplers, and arthroscopic shavers.
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This is part of the "mythos" that happens in anesthesia... be it residency, various and competing textbooks, the often confusing and contradictory data published in various journals, or just word of mouth.
Fact is, pretty much no one reads package inserts anymore.
http://www.pgpharma.com/pi/US-DantriumIV.pdf
I'm not sure where you heard the "2.5 mg/kg" dose... maybe you were thinking about the prophylactic dose (which no one uses... we just strictly avoid triggering agents)?
So, I'm not going to argue that probably MANY patients need a lot more. And, I'm sure we could argue all day long about what actually constitutes the "best" starting dose. But, the fact is that this is what was published and approved by the FDA when the drug was submitted for registration.
If you get sued, you'd better - at the very least - be able to show that you gave the 1mg/kg dose, as I can assure you that this package insert is going to be blown-up to poster size and submitted as an exhibit by the plaintiff's attorney.
-copro
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MHAUS guidelines recommend 2.5mg/kg or 1mg/lbs (apparently some in medicine can't convert accurately). Check out www.mhaus.org
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2.5 mg/kg for dantrolene.
Reference MHAUS as per poster above. I want to emphasize that so that residents and med students aren't confused by misinformation.
MH is the only disease that I know of that we have to be the experts on because no one else will know.
Again:
2.5 mg/kg
Reference MHAUS as per poster above. I want to emphasize that so that residents and med students aren't confused by misinformation.
MH is the only disease that I know of that we have to be the experts on because no one else will know.
Again:
2.5 mg/kg
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THIS IS THE BOTTOM LINE...
So, it doesn't matter, dudes. However you slice it, she was underdosed.
I invite you guys to mix some of that stuff up sometime. Have you ever? I have. If you are waiting to give it while you're mixing it to get to the 2.5mg/kg dose, you're going to delay care. You treat until symptoms resolve anyway. I met the founder of MHAUS a couple of years ago at a meeting, and she told me that she feels there's too much mannitol in the stuff anyway.
Angels on the head of a pin. Personally, if I ever had to give it, I'm just going to keep giving it regardless of dose, MHAUS aside.
-copro
So, it doesn't matter, dudes. However you slice it, she was underdosed.
I invite you guys to mix some of that stuff up sometime. Have you ever? I have. If you are waiting to give it while you're mixing it to get to the 2.5mg/kg dose, you're going to delay care. You treat until symptoms resolve anyway. I met the founder of MHAUS a couple of years ago at a meeting, and she told me that she feels there's too much mannitol in the stuff anyway.
Angels on the head of a pin. Personally, if I ever had to give it, I'm just going to keep giving it regardless of dose, MHAUS aside.
-copro
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One of the first steps in treatment is getting help. One or two people should have no other job other than mixing the vials, because it is VERY difficult to mix.
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Agreed. Now, how do you do this in a small outpatient setting? (P.S. I personally know the guy who papered the warming of the sterile water for mixing.)
Also, more food for thought for those of you who think that the MHAUS recommendations, which are not evidence-based by the way, are written in stone...
http://www.ncbi.nlm.nih.gov/pubmed/15679136
-copro
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As I recall, this wasn't even an ASC but an office based facility. I would imagine that help just isn't there. Maybe survival is 95% in the best scenario. Numbers would be way to small for even a retrospective study, but I would venture a guess that the 95% survivability goes way way down when you're outside of the hospital without labs, lines and help. (Edit: http://journals.lww.com/anesthesiol...Outcomes_of_Malignant_Hyperthermia_in.19.aspx Mortality from 2000 to 2005 shows 20% if transferred to a hospital emergently). I'm not saying that what they did was right, but for the lawyers to make a blanket statement like this is an easily treatable disease is very bold on their part. This is a serious life threatening condition that kills quickly.
Here is a link to a story of a 16 year old that had MH under the best conditions (in hospital, called for help immediately, Dantrolene given in sufficient doses, cooling equipment available, labs and ICU in house) This was in 2006. Outcome unfortunately was the same:
http://www.apsf.org/resource_center/newsletter/2006/summer/malignant.html
Here is a link to a story of a 16 year old that had MH under the best conditions (in hospital, called for help immediately, Dantrolene given in sufficient doses, cooling equipment available, labs and ICU in house) This was in 2006. Outcome unfortunately was the same:
http://www.apsf.org/resource_center/newsletter/2006/summer/malignant.html
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Which, going back to my original post in this thread, is why I would suggest that one providing anesthesia in such an environment should routinely avoid all triggering agents (i.e., do a TIVA). Problem solved.
-copro
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The one case I was aware of in residency where they thought the patient had MH, they gave a total of about 15 mg/kg in the first 24 hours. We reviewed it as part of our M&M.
Caffeine-halothane contracture test later disproved it. This is an exceedingly rare condition. I feel bad for any anesthesiologist who has this case, and misses it and/or can't effectively treat it. You're going to probably get sued, and - no matter what happens to the patient - it ain't going to be pretty.
-copro
Caffeine-halothane contracture test later disproved it. This is an exceedingly rare condition. I feel bad for any anesthesiologist who has this case, and misses it and/or can't effectively treat it. You're going to probably get sued, and - no matter what happens to the patient - it ain't going to be pretty.
-copro
