Heart Expelled Through Chest Wall, Sternotomy Disaster

[Momoffuturemedstudent]

Saw this on Reddit, and thought you might find it interesting.

The ICU doctor settled for $2,300,000.

The ICU doctor’s group settled for $1,200,000.

Heart Expelled Through Chest Wall [Sternotomy Disaster]

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[GassYous]

Why would the icu settle for an obvious ct surgery mishap?
How is this even possible? They use thick wires that they twist together with large pliers to bring the sternum together.

 

[NYEMMED]

Crazy case.


But the lawyers went home with over $2million. That’s why they name everyone, it’s incentivized for them.

 

[GonnaBeADoc2222]

This seems....less than ideal.

 

[Dr Mantis Toboggan]

Why would the icu settle for an obvious ct surgery mishap?
How is this even possible? They use thick wires that they twist together with large pliers to bring the sternum together.

They argued the ICU docs didn’t sedate adequately and the tidal volumes were too high etc.

 

[Siggy]

They argued the ICU docs didn’t sedate adequately and the tidal volumes were too high etc.

I’m willing to bet that the surgeon wanted the 700+ tidal volume to “recruit the alveoli.”

 

[Rekt]

Why would the icu settle for an obvious ct surgery mishap?
How is this even possible? They use thick wires that they twist together with large pliers to bring the sternum together.

I thought the same until I read the full paper. Essentially patient had days and days of coughing and vent desynch. CT surgery argued that they verbally told intensivist that the patient needed more sedation and to start paralytics but of course not documented. Although I can easily see this happening.

Also, the plaintiffs took advantage of what we already do best... Infighting amongst each other. Essentially made it a ICU vs surgery vs hospital case. Also didn't help the primary surgeon knew that there's was some wound non union/dehiscence, but went on vacation with plan of reevaluating after he got back. IIRC CT surgeons settled for 250k each.

Sounded like he didn't die immediately. I'm wondering if it would have been possible to stitch the RV. Would have been interesting to see in person. But it sounds like a typical intensivist at home and mid level running ICU issue too.

 

[thegenius]

Crazy case.


But the lawyers went home with over $2million. That’s why they name everyone, it’s incentivized for them.

Yea it's so stupid. That money should go to the pt's survivors.

How is the legal field, and the medical field, advanced when lawyers are the principal beneficiaries this kind of obvious error [ which appears to be on the CT surgeon ].

That dingus CT surgeon should have been 100% liable. What is the ICU doc supposed to do?

Much of what gets me in these medical liability cases is that liability is not even applied to the right parties. If the CT Surg got nailed for 4M because he didn't close the chest right, at least that would make some sense.

 

[thegenius]

They argued the ICU docs didn’t sedate adequately and the tidal volumes were too high etc.

So you paralyze and sedate the pt for 3 days while the CT surgeon goes on vacation, AND THEN he comes back and fixes it? The CT Surgeon should be held liable for that silly recommendation.

 

[thegenius]

This case (and the heart exploding out through the chest) reminds me of an "Untold Stories of the ER" episode where a guys eyeball popped out of the socket. They had a re-enactment of that. This dudes eyeball was totally out of the socket and everybody was screaming. LOL. The ER doc called ophtho and was told to "simply push the eye back into the socket and I'll be right in" LMAO

The comedy of this all
hearts exploding out of the chest and "blood everywhere"
eyeballs popping out of sockets.

Next we need a woman delivering a turtle and not an infant, and somehow get plantiff lawyers to sue the OB/Gyne, hospital, and ER doc all at the same time.

 

[allantois]

I still remember being lectured by an OBGYN and his words of wisdom about deliveries.. you can't put the s*** back into the horse once it's out

 

[Siggy]

I still remember being lectured by an OBGYN and his words of wisdom about deliveries.. you can't put the s*** back into the horse once it's out

Shoulder dystopia would like to have a word.

Of course if you get to the point where breaking the clavical didn’t work and you’re looking at a crash c-section, then you’re unlikely to have a good outcome.

 

[Rekt]

You guys know this isn't normal right? Purely an American thing. We should be pointing fingers at med mal in America not other docs.

This guy with hx of HTN, DM, HLD and severe CAD at 51 probably looking like Jabba the hut injecting McDonald's into his coronaries for 50 years undergoes a very high risk procedure and has a complication.

The end results should be "we did every thing we could and he died". There was no intent to kill this patient. Minor medical neglect maybe but everything is worse on paper and hindsight. We all know that.

Not sure how giving family millions of dollars solves anything. Just increasing the likelihood of general population looking for their lottery ticket.

 

[RustedFox]

Shoulder dystopia would like to have a word.

Of course if you get to the point where breaking the clavical didn’t work and you’re looking at a crash c-section, then you’re unlikely to have a good outcome.

Here in Florida we all pay a yearly 250.00 stick-up fee to the Neurological Injury Compensation Act Fund (NICA) to settle these cases collectively.

Yep. Google that.

 

[Siggy]

Here in Florida we all pay a yearly 250.00 stick-up fee to the Neurological Injury Compensation Act Fund (NICA) to settle these cases collectively.

Yep. Google that.

I’m aware. I need to poke my company again so I get my NICA cost reimbursed.

 

[GassYous]

I thought the same until I read the full paper. Essentially patient had days and days of coughing and vent desynch. CT surgery argued that they verbally told intensivist that the patient needed more sedation and to start paralytics but of course not documented. Although I can easily see this happening.

Also, the plaintiffs took advantage of what we already do best... Infighting amongst each other. Essentially made it a ICU vs surgery vs hospital case. Also didn't help the primary surgeon knew that there's was some wound non union/dehiscence, but went on vacation with plan of reevaluating after he got back. IIRC CT surgeons settled for 250k each.

Sounded like he didn't die immediately. I'm wondering if it would have been possible to stitch the RV. Would have been interesting to see in person. But it sounds like a typical intensivist at home and mid level running ICU issue too.

You shouldn't cough out your heart from vent desynchrony...

These days many patients are being extubated same day. More sedation and paralysis (?). Crazy.

 

[Birdstrike]

Moral of the story: When you have a horrendously bad outcome and one of your patient’s hearts explodes out of his chest on your watch, settle early. Don’t put yourself on trial for years, suffer through that process, then be forced to settle.

 

[Apollyon]

I still remember being lectured by an OBGYN and his words of wisdom about deliveries.. you can't put the s*** back into the horse once it's out

Zavanelli maneuver.

 

[bravotwozero]

Here in Florida we all pay a yearly 250.00 stick-up fee to the Neurological Injury Compensation Act Fund (NICA) to settle these cases collectively.

Yep. Google that.

You know what, I’ll take that over getting sued for a delivery issue.

 

[RustedFox]

You know what, I’ll take that over getting sued for a delivery issue.

Shouldn't have to do either.

 

[pollyspockets]

Tangential, but I wonder if the dogma of triple vessel disease needs a cabg needs to be challenged. With all the new data regarding medical therapy being superior to stents in all but occlusive MI I wonder if we should be doing less cabgs and more antianginals

 

[greatnt249]

Tangential, but I wonder if the dogma of triple vessel disease needs a cabg needs to be challenged. With all the new data regarding medical therapy being superior to stents in all but occlusive MI I wonder if we should be doing less cabgs and more antianginals

There's a significant difference between saying that medical therapy is superior to PCI/revascularization and that PCI/revascularization does not show superiority to optimal medical therapy...in stable angina. The patient in question had an NSTEMI.

 

[CoolDoc1729]

There’s a lot of talk in that paper about communication issues. I feel like if the plan had been communicated very clearly to the ICU attending as : I am going on vacation, this patient has a chance of something catastrophic happening , I’ll fix it on Tuesday but in the meantime just keep him paralyzed and vented for 4 days … I don’t think the icu Dr would have accepted that plan? It seems like a pretty insane plan tbh

 

[cyanide12345678]

You guys know this isn't normal right? Purely an American thing. We should be pointing fingers at med mal in America not other docs.

This guy with hx of HTN, DM, HLD and severe CAD at 51 probably looking like Jabba the hut injecting McDonald's into his coronaries for 50 years undergoes a very high risk procedure and has a complication.

The end results should be "we did every thing we could and he died". There was no intent to kill this patient. Minor medical neglect maybe but everything is worse on paper and hindsight. We all know that.

Not sure how giving family millions of dollars solves anything. Just increasing the likelihood of general population looking for their lottery ticket.

Not everyone getting a cabg is obese and unhealthy. Genetics matter unfortunately. Dad who has always weighed 135-145 lbs, well controlled DM2, A1C always less than 7, never smoked, well controlled hypertension and well controlled HLD had a cabg in his early 50s.

Last stroke work up showed a 100% R ICA and 99% left ICA a decade ago in his 60s.

he literally exercises regularly, eats fruits and vegies everyday in small controlled portions. It’s all genetics. I’m probably getting a MI in 15-20 years since I’m unhealthier than him in every way -_-

 

[GassYous]

Tangential, but I wonder if the dogma of triple vessel disease needs a cabg needs to be challenged. With all the new data regarding medical therapy being superior to stents in all but occlusive MI I wonder if we should be doing less cabgs and more antianginals

CABGs and stents are different.
CABGs have a mortality benefit in certain populations, stents don't.

 

[WilcoWorld]

There’s a lot of talk in that paper about communication issues. I feel like if the plan had been communicated very clearly to the ICU attending as : I am going on vacation, this patient has a chance of something catastrophic happening , I’ll fix it on Tuesday but in the meantime just keep him paralyzed and vented for 4 days … I don’t think the icu Dr would have accepted that plan? It seems like a pretty insane plan tbh

Agreed - tough to tell from my vantage point, but there are two possibilities I can think of:

1 - I've got tickets to Cancun, treat the dehiscence with rocuronium. Cee U Next Tuesday!
2 - Yikes, this guy is super sick. Too sick for me to take to the OR. Can you use your ICU magic to try and get him well enough for surgery when I'm back on Tuesday?

Plan 2 makes sense, plan 1 probably deserves a lawsuit.

 

[WorkNoteEmergency]

Sounds like the kind of thing that would show up in my rural ER day after discharge from academic medical center 1.5 hrs away. The one that's always full and doesn't take transfers.

 

[ERRES2288]

Yikes presumably this was above policy limits so ICU doctor likely on the hook for over a million in personal assets

 

[BoardingDoc]

Yikes presumably this was above policy limits so ICU doctor likely on the hook for over a million in personal assets

This wasn't damages awarded, this was a settlement so I would imagine that it is going to be covered by insurance.

 

[CajunMedic]

Sounds like the kind of thing that would show up in my rural ER day after discharge from academic medical center 1.5 hrs away. The one that's always full and doesn't take transfers.

Same in my community shop. Or, I can get them to accept, but I can't get HEMS due to weather and no ground crew either has the equipment/experience, or willing to pick up the HEMS crew for ground transport

 

[anonperson]

CABG is hugely invasive but the surgery works well. Having had a family member go through it, it is an impressive medical feat.

The pathology report is interesting. Cardiac surgeon recommended 4 vessel CABG. Pathology report mentions two grafts only. Patients IMA is missing but not grafted.

Bad case. You have a dehiscence and then leave town. Optics are not good. Why couldn't the other cardiac surgeon take him back for the closure? If you are sharing call, that comes with the territory.

I have taken back other people's complications back when taking call. It's not ideal but what can you do?. Liability is always an issue but can't just let the patient suffer.

 

[NYEMMED]

CABG is hugely invasive but the surgery works well. Having had a family member go through it, it is an impressive medical feat.

The pathology report is interesting. Cardiac surgeon recommended 4 vessel CABG. Pathology report mentions two grafts only. Patients IMA is missing but not grafted.

Bad case. You have a dehiscence and then leave town. Optics are not good. Why couldn't the other cardiac surgeon take him back for the closure? If you are sharing call, that comes with the territory.

I have taken back other people's complications back when taking call. It's not ideal but what can you do?. Liability is always an issue but can't just let the patient suffer.

I’m pretty sure the second surgeon would have been dropped if they did go back for closure. Or maybe not even get sued at all because a heart may not have exploded through the chest

On second thought I also feel bad for the nurse that was covered in blood by the exploding heart…

 

[ERRES2288]

This wasn't damages awarded, this was a settlement so I would imagine that it is going to be covered by insurance.

Is this common where an insurance company will settle above limits and pay above limits? Is it because they don’t want to front the cost of a trail if they know they will lose?

 

[TooMuchResearch]

Not everyone getting a cabg is obese and unhealthy. Genetics matter unfortunately. Dad who has always weighed 135-145 lbs, well controlled DM2, A1C always less than 7, never smoked, well controlled hypertension and well controlled HLD had a cabg in his early 50s.

Last stroke work up showed a 100% R ICA and 99% left ICA a decade ago in his 60s.

he literally exercises regularly, eats fruits and vegies everyday in small controlled portions. It’s all genetics. I’m probably getting a MI in 15-20 years since I’m unhealthier than him in every way -_-

He has DM, HTN, and HLD. This isn't healthy.
Familial hypercholesterolemia or some other genetic issue?

 

[WilcoWorld]

I also feel bad for the nurse that was covered in blood by the exploding heart…

Perfect opportunity for me to drop this little known gem into the thread:

 

[cyanide12345678]

He has DM, HTN, and HLD. This isn't healthy.
Familial hypercholesterolemia or some other genetic issue?

No named high risk disease, but still fairly crappy genetics. All of those despite an incredibly healthy lifestyle, being incredibly skinny, exercising and eating right.

Genetics always wins.

 

[NYEMMED]

Is this common where an insurance company will settle above limits and pay above limits? Is it because they don’t want to front the cost of a trail if they know they will lose?

They settle within the policy limits.

 

[GassYous]

No named high risk disease, but still fairly crappy genetics. All of those despite an incredibly healthy lifestyle, being incredibly skinny, exercising and eating right.

Genetics always wins.

All of those diseases make him high risk what are you smoking
He is "va healthy"

 

[VA Hopeful Dr]

All of those diseases make him high risk what are you smoking
He is "va healthy"

No kidding. The only major CV risk factor missing is the smoking.

 

[turkeyjerky]

All of those diseases make him high risk what are you smoking
He is "va healthy"

"I don't have high blood pressure or diabetes anymore, I'm on medications for them"

wtf was going on at this hospital? They keep the guy on a vent weaning/sedation holiday protocol when he's about to go back to the OR in 1-2 days. How did the CT surgeons not tell the nurses to "keep this guy down, his chest could tear open if he coughs too hard".

CABGs and stents are different.
CABGs have a mortality benefit in certain populations, stents don't.

Big difference between Left Main and triple vessel disease tho

 

[ERRES2288]

They settle within the policy limits.

I’d be surprised if icu doc had 2.3m in coverage

 

[Siggy]

"I don't have high blood pressure or diabetes anymore, I'm on medications for them"

wtf was going on at this hospital? They keep the guy on a vent weaning/sedation holiday protocol when he's about to go back to the OR in 1-2 days. How did the CT surgeons not tell the nurses to "keep this guy down, his chest could tear open if he coughs too hard".


Big difference between Left Main and triple vessel disease tho

CT surgeon peaced out for vacation.

 

[Siggy]

I’d be surprised if icu doc had 2.3m in coverage

Does umbrella insurance cover excess for malpractice?

 

[VA Hopeful Dr]

Does umbrella insurance cover excess for malpractice?

Not generally

 

[cyanide12345678]

All of those diseases make him high risk what are you smoking
He is "va healthy"

What I’m saying is…. Genetically predispositioned to have metabolic syndrome while being only 130 lbs, eating small meals of veggies and doing cardio 7 times a week for 30 minutes a day.

Yes those are risk factors. But you don’t have to be obese, lazy and unhealthy to have those risk factors. You can be doing everything right and still be screwed genetically to have metabolic syndrome. My comment was in response to someone assuming that probably the patient was a typical obese unhealthy dude. Maybe it was, but some people are just unlucky even if they do everything right and end up with a CABG.

 

[GassYous]

What I’m saying is…. Genetically predispositioned to have metabolic syndrome while being only 130 lbs, eating small meals of veggies and doing cardio 7 times a week for 30 minutes a day.

Yes those are risk factors. But you don’t have to be obese, lazy and unhealthy to have those risk factors. You can be doing everything right and still be screwed genetically to have metabolic syndrome. My comment was in response to someone assuming that probably the patient was a typical obese unhealthy dude. Maybe it was, but some people are just unlucky even if they do everything right and end up with a CABG.

What I'm saying is... you don't need to be obese and eating mcdonalds all day to be unhealthy. Your father is clearly unhealthy with several well known cardiac risk factors.

 

[cyanide12345678]

What I'm saying is... you don't need to be obese and eating mcdonalds all day to be unhealthy. Your father is clearly unhealthy with several well known cardiac risk factors.

Yes. Clearly unhealthy with a very healthy lifestyle. We’re saying the same thing.

I’m mentally ready for my first MI around 50 😂😂😂

 

[VA Hopeful Dr]

Yes. Clearly unhealthy with a very healthy lifestyle. We’re saying the same thing.

I’m mentally ready for my first MI around 50 😂😂😂

Just start taking Repatha

 

[Birdstrike]

No one gets more fed up with the rampant abuse of physicians with frivolous lawsuits, and having to obsess over defensive medicine, as I do. However, step back and think about this case from the perspective of this being your dad, brother or close friend.

How horrific. Your dad/friend/favorite uncle ends up expelling his frickin' heart OUTSIDE OF HIS CHEST, while AWAKE, because some punks refused to do the job they sign up for because, "It's the weekend." Then, the people that could have fixed the other peoples' mess, by either sedating the crap out of the guy, or by raising holy hell and calling every administrator, CT surgeon and hospital in town, to find someone to keep a guy from having his insides spit out of his chest and die the most agonizing death one can image, transferring and reporting the surgeons for an EMTALA violation if needed, didn't do so. And they probably leaned on the thought, "Oh well. If something bad happens it won't be my fault."

I just don't see how you get a CT report on a guy that says his sternum has dehisced and you don't lose your frickin' mind finding someone to take responsibility for fixing it immediately, even if you have to chew through a cement wall to do it.

 

[Dr Mantis Toboggan]

No one gets more fed up with the rampant abuse of physicians with frivolous lawsuits, and having to obsess over defensive medicine, as I do. However, step back and think about this case from the perspective of this being your dad, brother or close friend.

How horrific. Your dad/friend/favorite uncle ends up expelling his frickin' heart OUTSIDE OF HIS CHEST, while AWAKE, because some punks refused to do the job they sign up for because, "It's the weekend." Then, the people that could have fixed the other peoples' mess, by either sedating the crap out of the guy, or by raising holy hell and calling every administrator, CT surgeon and hospital in town, to find someone to keep a guy from having his insides spit out of his chest and die the most agonizing death one can image, transferring and reporting the surgeons for an EMTALA violation if needed, didn't do so. And they probably leaned on the thought, "Oh well. If something bad happens it won't be my fault."

I just don't see how you get a CT report on a guy that says his sternum has dehisced and you don't lose your frickin' mind finding someone to take responsibility for fixing it immediately, even if you have to chew through a cement wall to do it.

I like how the surgeon called the wife to his office for a meeting after the fact. Yeah, that’s gonna smooth everything over.