Definitely smoke.
But the scenario that you are proposing nased on your interpretation of the prosecution witness testimony is not one of compassionate end of life, but rather conspiracy to defraud the family into believing the patient is dying for the purposes of killing them off.
I haven't worked a ton of places but every place I have worked titrated their paralytic drip using train of four.
I'm not doing much interpreting. I'm mostly just reading news articles about the testimony and posting quotes of that testimony.
One could argue that quoting out of context is an act implied interpretation.
Yeah, that’s probably true. I’m not an Intensivist so my exposure is mostly related to dropping pts off and getting accosted over the presence or absence of paralysis/reversal which makes me think ICUs aren’t actually reversing pharmacologically and by and large doing so via the tincture of time.
The pain from a marathon is unrelated to lactate. Lactate is not painful in any situation
Show me where I quoted "out of context" along with the relevant context you think I left out and show how it significantly changes meaning. Simply demonstrating an instance where I didn't post a massive wall of text, or all 8 hours of a day's testimony, which no one would read or watch, doesn't count. Very few people read posts longer than 100 words or watches videos over 30 seconds.
It's actually a complicated question. I'm aware that "lactic acid buildup" has been debunked as the cause of delayed onset muscle soreness. However, the question came up in related to testimony, where @AlmostAnMD (I think?) got frustrated with an expert saying "lactic acid doesn't cause pain" and assumed that was an immediate impeachment of his credibility (it doesn't). Coincidentally, I just ran a marathon 2 1/2 weeks ago and it was painful. I'm not sure how much lactate had to do with it, but it did hurt. Just not enough to keep me from signing up for another one April 18th. (Boston; first time)
I'm sure.
Ugh, that's way underpaid... way way way underpaid. You get $600/hr for reviewing documents. I wouldn't testify in a court for less than $15,000 per day.
HIPAA doesn't apply to criminal cases. Any judge can order medical records to be exposed in a criminal case.
I require a 2-day minimum for courtroom testimony. I won't do it by the hour. I review records by the hour. Different rate for state medical board vs. defense vs. plaintiff. I quoted one plaintiff $1000/hr for records review, $2500/hr for deposition, and $20,000/day with a 2-day minimum for courtroom testimony. Surprisingly, they bit. I was hoping it went to trial but it didn't. Didn't feel bad at all about it because the doc screwed up royally and had a cocky attitude that he never did anything wrong ever in his entire career. He still didn't see what his mistake was and how it harmed the patient (even to this day after settling for nearly a mil).
Damn. You’re even higher than me. Lol. Good for you, though.
I've served as an expert witness many times, including for my state's medical board, and have solved the problem of what to charge by simply doing the work pro bono. I do have a requirement, which is that after reading all the medical records and listening to depositions, etc. I be allowed to testify according to my honest opinion of the case. I've testified for plaintiffs as well as defendants and a few times attorneys have decided not to "hire" me as their expert after having read my preliminary opinion of the case...
I think that's great, actually.
Except lactate production during exercise is not due to muscle ischemia, nor does muscle ischemia occur.
Yeah. He's a professional expert witness. I believe that he stated that 20% of his income is from being an expert witness. This is his first criminal trial.
nypost.com
This is not very far from me and the nurses locally are in an uproar. It will be difficult to push anyone here to do more work beyond perceived safe limits.Negligent homicide: Found guilty.
Doc orders versed. Nurse accidentally pulls and injects vecuronium. Patient dies. Nurse admits mistake. Takes responsibility. Convicted of homicide.
Ex-nurse found guilty in woman’s death after accidentally injecting her with wrong drug
A former nurse in Tennessee has been convicted in the accidental death of a patient after she injected her with a paralyzing drug instead of a sedative. RaDonda Vaught, 38, was convicted by a jury …
Yeah, I can see the overcorrection. Nurses won’t want to push anything, verbal orders 100% gone etc.
Lots of talk of cover ups etc.
well if it was 5 mg/ml it could be 🙂 but ya - I get what you are saying.
Right. If combined with an opiate, other sedative, the patient had alcohol on board or had otherwise compromised respiratory status, it could be. But 10 mg alone, in an otherwise healthy adult, not likely.
Interesting twist for this thread. It's now saying 10 mg of versed is fatal, but add 2,000mcg fentanyl to it and it's 'compassion.'
I don't know if @Robotic Wis-Hipple previous stated that large fent doses were compassion vs fatal. I do think that nearly everyone in this thread disagrees with the comment that 10mg of versed is fatal. Hell, I give 10mg of versed to agitated patients once a month.
Much has been made about the nurse admitting her mistake but unless she used the whole vial worth she would have needed to show the vial to another nurse regardless of what happened with the patient to waste the remainder. So I am not ready to laud her for fessing up if it was inevitable that the error would be identified by the other nurse during the waste process.Guilty of negligent homicide.
Versed ordered. Nurse accidentally pulls and injects vecuronium. Patient dies. Nurse admits mistake. Takes responsibility. Convicted of homicide.
Ex-nurse found guilty in woman’s death after accidentally injecting her with wrong drug
A former nurse in Tennessee has been convicted in the accidental death of a patient after she injected her with a paralyzing drug instead of a sedative. RaDonda Vaught, 38, was convicted by a jury …
that is actually a good point I have not ready anything about - although I could have easily seen another RN signing off on the waste without even checking - if I had a dollar for everything that happened.....
I took them to mean 10cc of the standard 5mg/ml solution, so 50mg of versed. Still not uniformly fatal, but potentially dangerous as a rapid IV push.
To a 70yo head bleed? That’s apnea inducing. Come on.
Ha! I have always maintained that initially I believed it was unlikely given as a bolus and it’s PLAUSIBLE that in significantly tolerant patients on high continuous infusion of fentanyl maybe 1000mcg wasn’t immediately fatal. But also always maintained it was unnecessary and likely apnea inducing if bolused.
The prosecution is supposedly going to rest tomorrow. Defense might begin tomorrow afternoon.
I got 10mg iv push versed for the block before my rotator cuff repair and apparently screamed in pain while it was being done though the amnestic effect worked so I don't recall it. But that was because I told them about the 9 of versed and 250 of fentanyl I had to get for an egd previously.
I call BS on 10mg IVP versed for an interscalene block. I mean the vast majority get 2mg versed and 50-100mcg of fentanyl when being done by trainees. In the private world 2mg versed and local before the block needle stick is routine.
You call bs on it having happened? Or you disagree with them having done it? Or you disbelieve that I was awake and responding to pain vocally after it?
Um…. Yes, yes, and no I can believe you were responding to pain during the block.
I suppose it was because I was a colleague rather than some rando but I assure that was the dose given and what we had discussed before that dose was selected, and I am exceedingly glad I found someone who didn't consider it BS and I didn't have to remember that pain (my parents were allowed to stay for it and my mom had to stop my dad from intervening due to my cries). Same for the anesthesiologist who believed me when I was just a lowly med student and made sure I got good dosing for my thyroid (not as good though because I still had enough pain to wish I got more meds both in pacu and on the floor but it could have been much worse, as it as after my appy, nasal septoplasty, and after the local wore off from my wisdom teeth extraction).
Black hair and brown skin which made me worry people would just assume I am a secret drug/alcohol abuser. And I have both A and B which is a bad combo. Luckily I have found that multimodal strategy is effective for me so that helps.
