Post Operative Blood loss

[Cherrypicker999]

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Post subject: Blood loss and left ventricular failure

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I would appreciate a view on this:

A 76 year old man has elective surgery to remove gall stones using laproscopic surgery.
He has no history of heart problems.

Haemoglobin levels are as follows:

9:30am 13.6 (surgery started at 9:30 and ends at 11:30am)
2pm 4.4
3pm 3.2

Estimated blood loss during surgery = 500ml

Can one conclude (1 or 2):

A. The patient suffered modest post-operative blood loss
B. The patient suffered severe post-operative blood loss

Is the answer obvious?

The patient suffers left ventricular failure at 3pm and pronounced dead
at 3:50pm.

Would such a degree of blood loss result in left ventricular failure?


Can one conclude (1 or 2):

1. Given that he had little evidence of significant pre-existing heart disease and given that fluid/blood loss was modest post-operatively, the severity of his heart problems are difficult to account for.”

2. Given that he had little evidence of significant pre-existing heart disease and given that fluid/blood loss was severe post-operatively, the severity of his heart problems can be explained by the severe blood loss.

Is the answer obvious?


The operation took 2 hours and blood loss was estimated to be 500ml
(higher than expected).
This patient was hyoptensive upon being transferred to recovery.
His blood pressure could not be maintained by gelofusin.

Should such blood loss have been diagnosed by the anaethetist
or could he really claim it could not be diagnosed.

What would cause such a massive blood loss?
Eg a clip coming off, "nicking" a vessel etc?

Regards

 

[VolatileAgent]

first off, someone had to be bolusing the dude because you can't register a drop in crit like that without giving fluid back. so, they obviously had to know he was losing massive volume somewhere. not taking him back the OR to open him up when they got the first post-op crit was mistake #2.

mistake #1 was not opening the guy in the OR when it was reported he lost 500cc of blood during a friggin' lap chole! that should have told any surgeon who was even remotely tuned in that they probably nicked a pumper around the gall bladder. it's not that uncommon for patients to have a redundant arterial supply (or multiple branches) that, if the surgeon is in a hurry, can get stripped-off and bovied through without much care. (i try to make a point to peer over the curtain and watch the screen when they are taking down the gall bladder.)

other than that, i don't know how you pin this one on the anesthesiologist. sure, he/she could've said "hey, man, you lost 500cc during a lap chole. what's up?" but, who knows the dynamics. certainly, the guy should've been rushed back to the OR when the first crit came back, though. whoever in the ICU or post-op noted that also dropped the ball.

 

[Idiopathic]

how could the patient not have suffered severe post-op blood loss, when he essentially bled out?

most likely, the patient had mildly complex anatomy. ive seen several lap choles performed by somewhat skilled surgeons that were essentially a tremble away from going very badly. laziness (not checking the liver for lacs, not irrigating the GB fossa, etc), poor technique (not adequately dissecting the cystic artery and placing a clamp on 85% of a major branch, thinking you had it all). this may explain a 2 hour lap chole also (or maybe residents were involved)

major hidden liver lac is a possibility too, something that might not be readily apparent without thorough examination.

pretty crazy that a 9 gram drop in hemoglobin with only 500cc of accounted for blood loss wasnt stat-rushed back to the OR though.

i think that asymptomatic heart failure is difficult to recognize, and older people can certainly teeter on the edge of failure, but this is more likely a high output failure state, due to massive hypotension with the blood loss, or perhaps a sizable hematoma collected, compressing arterial outflow, causing ventricular strain and the resultant failure.

thats what i think

 

[Cherrypicker999]

This is what the pathologist concluded:

"This man suffered acute left ventricular failure precipiated by a laproscpic choelecystectomy. Although the operation was technically difficult there are no features to suggest that poor or careless surgical technique has contributed to the outcome.
GIVEN THAT HE HAD LITTLE EVIDENCE OF SIGNIFICANT PRE-EXIISTING HEART DISEASE, AND GIVEN THAT FLUID/BLOOD LOSS WAS RELATIVELY modest, POST OPERATIVELY, THE SEVERITY OF HIS HEART PROBLEMS ARE DIFFICULT TO ACCOUNT FOR.

------------

Modest blood loss? Which planet is he on?
This was pointed out to him.
He did not change his report!

Is he incompetent or corrupt?

 

[Cherrypicker999]

Op began 9:30am - first cut, Hg level was 13.6

1. During the op the gall bladder wall was noted to be very thickened and the gall bladder was welded to the liver surface with dense adhesion involving omentum and along the lesser curve.

2. The adhesions wee broken down gently and were patently quite fibrotic and vascular.

3.It proved very difficult to even grip the gall bladder and different grapples had to be used. The decision was taken to proceed from different angles.

4. The gall bladder was finally lifted off the liver bed using diathermy.

5. The gall bladder was retrieved via the umbilical port.

6. At the end of the op there was no significant ooze from the liver.


Time BP
09:00 110/70
09:05 100/58
09:10 90/52
09:15 80/48
09:20 92/59
09:25 92/52
09:30 100/50 First CUT
09:35 120/69
09:40 140/82
09:45 130/78
09:50 140/80
09:55 140/80
10:00 132/74
10:05 131/72
10:10 138/68
10:15 130/65
10:20 122/58
10:25 110/55
10:30 110/54
10:35 110/54
10:40 110/54
10:45 110/56
10:50 120/58
10:55 120/58
11:00 120/62
11:05 111/59
11:10 113/50
11:15 112/50
11:20 90/47
11:25 80/32
11:30 80/32
11:35 92/40
11:40 88/38

RECOVERY


Time BP
11:55 62/41
12:00 74/44 500ml Gelofusin TEMP 34 degrees Celcius
12:06 76/51
12:10 100/58
12:15 85/53
12:20 90/54
12:25 83/61
12:30 92/66
12:35 99/61 Gelofusin ended
12:45 114/68 Dex Saline 1 litre
13:00 99/66
13:10 70/48
13:20 72/52 Ephedrine 3mg/6mg Dex Saline
13:40 65/39 Ephedrine 6mg IV
13:50 88/59
gap 14:20 62/34
gap 14:25 51/34
1/2 hour 14:30 60/46 Frusemide
Readings ended


11:55 Recovery BP 62/41 Low
12:00 BP 74/44 Anaesthetist informed
Gelofusin 500ml over 30mins
BP increased slowly
Temperature 34 degrees - given warming blanket

13:00 Temperature 35 degrees
ECG performed

13:30 Unable to get further peripheral lines
Blood pressure decreasing
Vomited
Ultrasound carried out by
SMALL AMOUNT OF PERITONEAL FLUID no untoward fluid

14:15 Catheterised - 14" and attached to urometer

14:30 40ml IV Frusemide given
CVP line inserted
Desaturated and intubated
CPR commenced in Recovery! CPR in recovery

14:45 Transferred to theatre
Abdomen opened

15:50 Died


SURGEON NOTES AFTER OPERATION

Gall bladder welded to liver
Fibrotic and vascular
Hard to graple
Lifted off
3 large surgicel to gall bladder bed looked fairly dry
Check Hb at 3pm

12:30 Hypotensive in recovery
Opiate related?
Myocardial?
Bleed?

NOTES (RADIOLOGIST)
13:45 Small amount of free peritoneal fluid
Small haematoma near gall bladder bed

OPEN SURGERY NOTES 16:30 RETROSPECTIVE
14:45 Start --- OPENED UP AGAIN
Left lobe of liver, anterior surface breached inadvertently
1-1.5l of heavily blood-stained washout
3x4x5 clot in gall-bladder bed
2 pieces of surgicel
2 superficial venous bleeding points in middle of gall-bladdder bed
Superficial Anterior tear in liver
Stutured - reasonable hameostatic control
Gall-bladder bed bleeding points stutured
Left lateral thoractomy
No further active bleeding was seen
Died 16:00


ANAETHETIST- RETROSPECTIVE

12:00 Called to review blood pressure (70Hg Systolic)
Gelofusin 0.5l over 30mins, then review

13:10 Called again due to Hypotension (70/48)
Morphine given
Gelofusin 500ml IV
Dext Saline 300ml IV
Suspect Post Operative Hypovotaemia
Opiate related hypotension
Acute Myocardial ischemia
ECG
If Hb is less than 7.5 give 2 units of blood



13:15 Velflon inserted and blood sample taken

13:20 Theatre lost stopped.
2 units of blood
See cardiologist
Give fluids - gelofusin 1l started
Catherise
CVP Line
Ultrasound
Refer to ITU/MDU

14:00 Cardiologist busy. ECG reviewed simus rhytm
Heart rate 80

14:10 CVP line inserted

14:20 Tachypnoeic
Hypotensive
Skin pale, sweating
O2 down to 90.96%
ITU called
Intubate
Inotropic support with CVP line
Could not insert art line few times
No ITU beds

14:30 Hb 4.4 Stated retrospectively at 18:30

14:35 Intubate
BP unrecordable

14:40 Cardiac arrest
ECG Simus Rythmn severe
Heart rate 110
No pulse
CPR

14:45 * Separate records, cardiac arrest in Theatre
14:50 * Separate records, 2 units of blood given *

15:00 Hb 4.4 Stated 3.2 retrospectively at 18:30
Start blood transfusion

15:05 CPR
Abdomen distended
Explore abdomen
Blood in abdomen was 1.5-2litres

Taken to theatre

Chest opened
Blood transfusion 13 units of blood

15:25 * Separate notes open cardiac massage *

15:40 No recordable pulse for 1 hour
Pupils dilated

15:40 * Separate notes, 1st DC shock 10-30-50

15:45 * Separate notes, 2nd DC shock 50-50-50

15:50 CPR stopped and pronounced dead


---------------

Blood sample taken at 13:15
CLAIMED NEVER REACHED LAB AND LOST

Claimed taken a sample at 2:30 - Hg 4.4 Results at 3:30pm
Claimed taken a sample at 3:00 - Hg 3.2

Why take 3rd sample if no results have been provided?
Seems odd!

If the first sample had not been lost Hg would have been low,
Blood transfusion may have been immediate – different outcome?


When abdomen was distended and second op undertaken the anaesthetist wrote 1.5 to 2litres of blood.

The surgeon claimed “blood stained fluid”

Was the second op necessary? The patient was as good as dead.
Was it to cover up a mistake?

What was the cause of the abdomen becoming distended – full of blood?
Where did the blood come from?

Pathologist claimed “modest blood loss”
All doctors claimed “modest blood loss”

Inquest undertaken and all doctors colluded “modest blood loss”

After inquest, hospital admits severe blood loss and claims it lost the first blood sample, it never reached the lab.



ANY FURTHER COMMENTS?

 

[VolatileAgent]

15:05 CPR
Abdomen distended
Explore abdomen
Blood in abdomen was 1.5-2litres

there's your answer right there. dude bled out. and heart muscle needs blood to work. if this had happened in the U.S., you'd have had plaintiff's attorney's climbing all over this one.

 

[toughlife]

Op began 9:30am - first cut, Hg level was 13.6

1. During the op the gall bladder wall was noted to be very thickened and the gall bladder was welded to the liver surface with dense adhesion involving omentum and along the lesser curve.

2. The adhesions wee broken down gently and were patently quite fibrotic and vascular.

3.It proved very difficult to even grip the gall bladder and different grapples had to be used. The decision was taken to proceed from different angles.

4. The gall bladder was finally lifted off the liver bed using diathermy.

5. The gall bladder was retrieved via the umbilical port.

6. At the end of the op there was no significant ooze from the liver.


Time BP
09:00 110/70
09:05 100/58
09:10 90/52
09:15 80/48
09:20 92/59
09:25 92/52
09:30 100/50 First CUT
09:35 120/69
09:40 140/82
09:45 130/78
09:50 140/80
09:55 140/80
10:00 132/74
10:05 131/72
10:10 138/68
10:15 130/65
10:20 122/58
10:25 110/55
10:30 110/54
10:35 110/54
10:40 110/54
10:45 110/56
10:50 120/58
10:55 120/58
11:00 120/62
11:05 111/59
11:10 113/50
11:15 112/50
11:20 90/47
11:25 80/32
11:30 80/32
11:35 92/40
11:40 88/38

RECOVERY


Time BP
11:55 62/41
12:00 74/44 500ml Gelofusin TEMP 34 degrees Celcius
12:06 76/51
12:10 100/58
12:15 85/53
12:20 90/54
12:25 83/61
12:30 92/66
12:35 99/61 Gelofusin ended
12:45 114/68 Dex Saline 1 litre
13:00 99/66
13:10 70/48
13:20 72/52 Ephedrine 3mg/6mg Dex Saline
13:40 65/39 Ephedrine 6mg IV
13:50 88/59
gap 14:20 62/34
gap 14:25 51/34
1/2 hour 14:30 60/46 Frusemide
Readings ended


11:55 Recovery BP 62/41 Low
12:00 BP 74/44 Anaesthetist informed
Gelofusin 500ml over 30mins
BP increased slowly
Temperature 34 degrees - given warming blanket

13:00 Temperature 35 degrees
ECG performed

13:30 Unable to get further peripheral lines
Blood pressure decreasing
Vomited
Ultrasound carried out by
SMALL AMOUNT OF PERITONEAL FLUID no untoward fluid

14:15 Catheterised - 14" and attached to urometer

14:30 40ml IV Frusemide given
CVP line inserted
Desaturated and intubated
CPR commenced in Recovery! CPR in recovery

14:45 Transferred to theatre
Abdomen opened

15:50 Died


SURGEON NOTES AFTER OPERATION

Gall bladder welded to liver
Fibrotic and vascular
Hard to graple
Lifted off
3 large surgicel to gall bladder bed looked fairly dry
Check Hb at 3pm

12:30 Hypotensive in recovery
Opiate related?
Myocardial?
Bleed?

NOTES (RADIOLOGIST)
13:45 Small amount of free peritoneal fluid
Small haematoma near gall bladder bed

OPEN SURGERY NOTES 16:30 RETROSPECTIVE
14:45 Start --- OPENED UP AGAIN
Left lobe of liver, anterior surface breached inadvertently
1-1.5l of heavily blood-stained washout
3x4x5 clot in gall-bladder bed
2 pieces of surgicel
2 superficial venous bleeding points in middle of gall-bladdder bed
Superficial Anterior tear in liver
Stutured - reasonable hameostatic control
Gall-bladder bed bleeding points stutured
Left lateral thoractomy
No further active bleeding was seen
Died 16:00


ANAETHETIST- RETROSPECTIVE

12:00 Called to review blood pressure (70Hg Systolic)
Gelofusin 0.5l over 30mins, then review

13:10 Called again due to Hypotension (70/48)
Morphine given
Gelofusin 500ml IV
Dext Saline 300ml IV
Suspect Post Operative Hypovotaemia
Opiate related hypotension
Acute Myocardial ischemia
ECG
If Hb is less than 7.5 give 2 units of blood



13:15 Velflon inserted and blood sample taken

13:20 Theatre lost stopped.
2 units of blood
See cardiologist
Give fluids - gelofusin 1l started
Catherise
CVP Line
Ultrasound
Refer to ITU/MDU

14:00 Cardiologist busy. ECG reviewed simus rhytm
Heart rate 80

14:10 CVP line inserted

14:20 Tachypnoeic
Hypotensive
Skin pale, sweating
O2 down to 90.96%
ITU called
Intubate
Inotropic support with CVP line
Could not insert art line few times
No ITU beds

14:30 Hb 4.4 Stated retrospectively at 18:30

14:35 Intubate
BP unrecordable

14:40 Cardiac arrest
ECG Simus Rythmn severe
Heart rate 110
No pulse
CPR

14:45 * Separate records, cardiac arrest in Theatre
14:50 * Separate records, 2 units of blood given *

15:00 Hb 4.4 Stated 3.2 retrospectively at 18:30
Start blood transfusion

15:05 CPR
Abdomen distended
Explore abdomen
Blood in abdomen was 1.5-2litres

Taken to theatre

Chest opened
Blood transfusion 13 units of blood

15:25 * Separate notes open cardiac massage *

15:40 No recordable pulse for 1 hour
Pupils dilated

15:40 * Separate notes, 1st DC shock 10-30-50

15:45 * Separate notes, 2nd DC shock 50-50-50

15:50 CPR stopped and pronounced dead


---------------

Blood sample taken at 13:15
CLAIMED NEVER REACHED LAB AND LOST

Claimed taken a sample at 2:30 - Hg 4.4 Results at 3:30pm
Claimed taken a sample at 3:00 - Hg 3.2

Why take 3rd sample if no results have been provided?
Seems odd!

If the first sample had not been lost Hg would have been low,
Blood transfusion may have been immediate – different outcome?


When abdomen was distended and second op undertaken the anaesthetist wrote 1.5 to 2litres of blood.

The surgeon claimed “blood stained fluid”

Was the second op necessary? The patient was as good as dead.
Was it to cover up a mistake?

What was the cause of the abdomen becoming distended – full of blood?
Where did the blood come from?

Pathologist claimed “modest blood loss”
All doctors claimed “modest blood loss”

Inquest undertaken and all doctors colluded “modest blood loss”

After inquest, hospital admits severe blood loss and claims it lost the first blood sample, it never reached the lab.



ANY FURTHER COMMENTS?

I see that this is your first post in the forum. Why are you asking this and how did you get access to all that information? Are you the plaintiff's lawyer? Your comments about the pathologist certainly make you sound like one.

 

[Lizard1]

I see that this is your first post in the forum. Why are you asking this and how did you get access to all that information? Are you the plaintiff's lawyer?

ding, ding, ding

 

[toughlife]

This is what the pathologist concluded:

"This man suffered acute left ventricular failure precipiated by a laproscpic choelecystectomy. Although the operation was technically difficult there are no features to suggest that poor or careless surgical technique has contributed to the outcome.
GIVEN THAT HE HAD LITTLE EVIDENCE OF SIGNIFICANT PRE-EXIISTING HEART DISEASE, AND GIVEN THAT FLUID/BLOOD LOSS WAS RELATIVELY modest, POST OPERATIVELY, THE SEVERITY OF HIS HEART PROBLEMS ARE DIFFICULT TO ACCOUNT FOR.

------------

Modest blood loss? Which planet is he on?
This was pointed out to him.
He did not change his report!

Is he incompetent or corrupt?

he is not incompetent but you, on the other hand, are corrupt.

 

[rugtrousers]

I see that this is your first post in the forum. Why are you asking this and how did you get access to all that information? Are you the plaintiff's lawyer? Your comments about the pathologist certainly make you sound like one.

Nice pickup, just when I was getting ready to feed into the madness...

 

[VolatileAgent]

hey, i got no problem discussing 'hypothetical' pending litigation. the anesthesiologist didn't do anything wrong. i think, if someone is trying to sue the anesthesiologist, they're barking up the wrong tree and likely to have a fruitless case.

go after the surgeon, dude. they chopped something up and then didn't do their job right afterwards. 500cc blood loss intra-op on a lap chole?!? that, by itself, is malpractice. should've opened the guy up then and there. and, that ain't the anesthesiologist's call. but, sounds like the ****diggers are trying to spread the blame out. i hope the anesthesiologist in question has a bulldog for a defense attorney.

out.

 

[toughlife]

hey, i got no problem discussing 'hypothetical' pending litigation. the anesthesiologist didn't do anything wrong. i think, if someone is trying to sue the anesthesiologist, they're barking up the wrong tree and likely to have a fruitless case.

go after the surgeon, dude. they chopped something up and then didn't do their job right afterwards. 500cc blood loss intra-op on a lap chole?!? that, by itself, is malpractice. should've opened the guy up then and there. and, that ain't the anesthesiologist's call. but, sounds like the ****diggers are trying to spread the blame out. i hope the anesthesiologist in question has a bulldog for a defense attorney.

out.

come on dawg.

 

[VolatileAgent]

come on dawg.

what, you want to pretend litigation doesn't happen? you seriously think some lawyer is phishing on this forum for a case strategy? i hope he prints this out and takes it to his client. you think anything we say here is going to change anything? the point is, from the sounds of what little snippet's been offered here (and if this is some lowlife plaintiff's attorney scrounging for information), the wheels of justice are already in motion. and, if anyone's going to take the advice of someone on an anonymous internet forum as an "expert opinion", then they deserve to get laughed out of court.

lighten up.

 

[Idiopathic]

This case is ugly 100 ways from Sunday. I think it should be left at that, especially in light of all the 'new' info.

 

[Idiopathic]

the anesthesiologist didn't do anything wrong

some might argue. its certainly best not to encourage the behavior of the OP, trying to get 'expert' opinion. i, at first, thought it was a board style question, with the 'is it obvious?' statements. however, that appears not to be the case.

 

[militarymd]

Did this case happen in UK or Europe?

 

[jetproppilot]

I see that this is your first post in the forum. Why are you asking this and how did you get access to all that information? Are you the plaintiff's lawyer? Your comments about the pathologist certainly make you sound like one.

Tough,

congratulations.

You've been hired as an FBI profiler.

Shift supervisor at that, with full benefits and a 401K match.

 

[toughlife]

Tough,

congratulations.

You've been hired as an FBI profiler.

Shift supervisor at that, with full benefits and a 401K match.

I am honored professor Jet.

 

[toughlife]

what, you want to pretend litigation doesn't happen? you seriously think some lawyer is phishing on this forum for a case strategy? i hope he prints this out and takes it to his client. you think anything we say here is going to change anything? the point is, from the sounds of what little snippet's been offered here (and if this is some lowlife plaintiff's attorney scrounging for information), the wheels of justice are already in motion. and, if anyone's going to take the advice of someone on an anonymous internet forum as an "expert opinion", then they deserve to get laughed out of court.

lighten up.

Did you ever learn during your clinical rotations to look at the whole picture??

Well, when I first saw the post I went to the surgery forum to see if he had posted the same question. Well, he hadn't. That made me think that he was looking for answers that were especifically related to the care that patient received from the anesthesia provider.

Second, the language he used in his post is not typical of a layperson or a physician. What do I mean? Well the words collude and inquest mean:

1) Collude: To act together secretly to achieve a fraudulent, illegal, or deceitful purpose; conspire.
2) Inquest: A judicial inquiry into a matter usually held before a jury, especially an inquiry into the cause of a death.

Now go back and put the meaning of those words in place of the actual words and reread the sentences in which they are used. You will see why this post is after something and is not just a mere inquiry. So yeah I think he is looking for something. And god knows I hate lawyers.

 

[Cherrypicker999]

No, I am from the family of the man who died.
If it was up to me, I would go to court.
I want answers and explanations.

I cannot understand the clear corruption as the pathologist was informed that there was evidence of significant blood loss. He did not change his statement.

I cannot understand how a pathologist can make such a statement.
All doctors lied.
The coroner believed the pathologist and said "blood loss argument was against the run of evidence."

The pathologist claimed no evidence of poor surgical tecnhqiue.

Then why did he bleed so much?
The scan showed very little blood.
If 1.5-2 litres of blood gathered in his abdomen over a short period, what caused it? Did a clip come lose? Or was he oozing blood all the time?

I did calculations and proved to the hospital he had significant blood loss.
They then accepted it. (I used to be a pharmacist).

Thanks

 

[Cherrypicker999]

This happened in England.
I am not a lawyer. I would like some opinions and perhaps answers.

A complaint was lodged at the healthcare commission and these useless people could not even conclude massive blood loss. After months they accepted it.
Yet, the hospital has stated in writing, they accept substantial post-operative blood loss.

This case us unlikely to go to court as the wife does not want to go through this. However, I want answers. I have all the medical notes (all what have been released). I obtained confidential notes from the coroner via the Freedom of Information Act.

My opinion is:
The average op takes around 1 hour, in this case it took 2 hours.
The gall bladder was fused to the liver, perhaps they should have opened up.
500ml blood loss is twice the average and that an estimate.
He was markedly hypotensive before sent to recovery. Why was he sent to recovery then?
Surely, he should have had a blood sample sent to the lab.
The doctors knew in that hospital it takes 1 hour to process the sample.
They took a sample at 1:15… it was lost and never arrived at the lab (admitted inw writing).

The major complication in this op is blood loss. They should have concentrated on this.
If bp could not be maintained by gelofusin, an ooze should have been suspected.

It is the anaesthetist’s responsibility to monitor the patient after the op and act upon the patients’ conditions. It appears the surgeon was arrogant and I suspect the scenario was: “This man has lost a lot of blood, perhaps you have nicked a vessel, his bp is low”. Surgeon says “Look I have done 200 of these ops, I have never had a bleed, it must be something else, eg opiate related or heart condition”.
(Both nonsense as the man had morphine many times without problems and no history of heart problems). The anaesthetist did not stand up to the surgeon.
There lies the issue.

But, this extent of blood loss should have been detected. It appears there was very poor clinical judgement. It was wait and watch. How can one wait for blood samples to confirm blood loss? It takes 1 hour to process, so is the patient to bleed to death before he decides to transfuse blood?

I blame both the surgeon and anaesthetist. The UK opinion seems to be the majority of blame lies with the anaesthetist. It’s his responsibility to monitor the patient after the op and take the lead and not be bullied by the surgeon.

Now, I am suspicious. Why did the abdomen become so distended over a short period? It was clearly blood. But from where and why? Was it a sudden gush?
What are the possibilities?

Was the second op necessary? The patient was probably dead. Was it to cover up the mistakes? Surgeon claims blood stained fluid, anaesthetist claims pure blood.

Then the pathologist. Did the doctors collude with him to hide blood loss?
At the inquest, that they all maintained modest blood loss.

The pathologist sent his report to the coroner (medically unqualified)
A letter was written to the coroner stating the pathologist may be wrong.
Look at Hg levels. Initial 13.6, later 4.4. and 3.2.
The pathologist stated he saw the letter.
He stood by his report.
I cannot understand this.
Is he the only doctor in the world to claim modest blood loss?

 

[Cherrypicker999]

Do you guys really think that any decent lawyer would post questions on an anonomous forum? He could not use those opinions in a court of law.
Surley, he would pay expert doctors for advice and invoice his client.
Lawyers want money! The doctors involved would have their own lawyers!
You should be less suspicious.
Remember, litigation in UK/USA is different.

I am not looking for who to sue. I would like honest opinions on what really went on and what the possibilities are.

 

[militarymd]

The practice of anesthesiology in the UK is quite different than that in the United States.

In the US, it is quite clear that the majority of the "blame" or "responsibility" lies with the surgeon.

The vast majority of perioperative care and management (other than providing intraop and PACU care) lies with the surgeon here in the US.

The role of the "anaesthetist" is broader in the UK....so it is difficult to assign "blame" based on the information you have provided...although you did detail pretty clearly the progression of care for this patient.

The lines of responsibility are not familiar to the posters on this forum...who I believe are mostly from N. America.

 

[DrMom]

Since the OP has posted multiple threads on this same topic & has no other posts here, it really appears to be someone coming here for medical advice. Because of this I am closing the threads.

To the OP: SDN is not for medical advice. Please do not post similar topics in the future.