Resident dint know how to work with vents!?

[RT2DO]

A NYC coronavirus patient died after inexperienced medical residents set her ventilator too high and it stopped her heart

The incident happened at Montefiore hospital in the Bronx in March, the Wall Street Journal reported on Wednesday.

news.yahoo.com

Came across this article about how a NY COVID patient died because apparently the family med resident did not know how to work with vents. Maybe the patient was sick enough and on the verge of coding already? Thoughts?

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[drmwvr]

A NYC coronavirus patient died after inexperienced medical residents set her ventilator too high and it stopped her heart

The incident happened at Montefiore hospital in the Bronx in March, the Wall Street Journal reported on Wednesday.

news.yahoo.com

Came across this article about how a NY COVID patient died because apparently the family med resident did not know how to work with vents. Maybe the patient was sick enough and on the verge of coding already? Thoughts?

And a FM resident would know how to use a ventilator how? As to your question, could not excessive tidal volume and/or peep create enough of an impediment to venous return in a critical patient to cause a problem? And using a ventilator is never in isolation of hemodynamic management, right? Again, why would a FM resident be facile in one, let alone both?

Missing your question here...

 

[RT2DO]

And a FM resident would know how to use a ventilator how? As to your question, could not excessive tidal volume and/or peep create enough of an impediment to venous return in a critical patient to cause a problem? And using a ventilator is never in isolation of hemodynamic management, right? Again, why would a FM resident be facile in one, let alone both?

Missing your question here...

I agree! Impeding venous return with overdoing volume or PEEP could very well have plummeted that pressure. But aren't FM resident supposed to get CC attending coverage? Or Respiratory Therapist that would atleast tell them that this is a bad vent change? The article says the patient died because the resident dint know anything about managing vents. Little excess, no? I am just being a curious soul here

 

[drmwvr]

I agree! Impeding venous return with overdoing volume or PEEP could very well have plummeted that pressure. But aren't FM resident supposed to get CC attending coverage? Or Respiratory Therapist that would atleast tell them that this is a bad vent change? The article says the patient died because the resident dint know anything about managing vents. Little excess, no? I am just being a curious soul here

You are aware of the situation in NYC? From the sound of your post, it doesn't seem as though that is so...

 

[coffeebythelake]

Agree likely due to excessive peep

 

[deleted162650]

Didn’t realize there was an “ON” button?

 

[KENY1]

Some vents are indeed confusing, they are all very different. He may just have put it on standby or off or on CPAP - there are many options. It is weird though there would be no alarms...

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[KENY1]

Just look at the new app VTA - ventilator training alliance - a new app the ventilator companies put together.

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[MoMoGesiologist]

Is anyone here working at an NYC hospital? Are sick patients really being managed by non-intensivists (residents, off service attendings, midlevels, etc)? If so, patients may be better off at home and having their doula/chiropractor/midwife managing them (probably not to that extreme but you know what I mean). If hospitals aren’t able to meet standard of care (an ICU patient should have an intensivist and/or RT), should they be taking care of these patients?

 

[Ronin786]

Is anyone here working at an NYC hospital? Are sick patients really being managed by non-intensivists (residents, off service attendings, midlevels, etc)? If so, patients may be better off at home and having their doula/chiropractor/midwife managing them (probably not to that extreme but you know what I mean). If hospitals aren’t able to meet standard of care (an ICU patient should have an intensivist and/or RT), should they be taking care of these patients?

They 100% are. That article is a POS. What does anybody expect a family resident to do when there are hundreds of ventilated patients and nobody to manage them. Flinging blame at them rather than the absurd response by everybody responsible in this country that put them in that situation. Absolute travesty. Poor resident probably feels absolutely putrid and 100% they were volunteering in trying to help.

I know for a fact that at major NYC institutions, non-anesthesia/IM residents are in charge of managing patients in the OR on anesthesia machines. With some supervisory oversight, but nothing that actually would meet any sort of standard. But what are you supposed to do when you have that many patients needing ventilators?

 

[Lexdiamondz]

Is anyone here working at an NYC hospital? Are sick patients really being managed by non-intensivists (residents, off service attendings, midlevels, etc)? If so, patients may be better off at home and having their doula/chiropractor/midwife managing them (probably not to that extreme but you know what I mean). If hospitals aren’t able to meet standard of care (an ICU patient should have an intensivist and/or RT), should they be taking care of these patients?

Yup, they are.

They 100% are. That article is a POS. What does anybody expect a family resident to do when there are hundreds of ventilated patients and nobody to manage them. Flinging blame at them rather than the absurd response by everybody responsible in this country that put them in that situation. Absolute travesty. Poor resident probably feels absolutely putrid and 100% they were volunteering in trying to help.

I know for a fact that at major NYC institutions, non-anesthesia/IM residents are in charge of managing patients in the OR on anesthesia machines. With some supervisory oversight, but nothing that actually would meet any sort of standard. But what are you supposed to do when you have that many patients needing ventilators?

In all fairness, the majority of ICUs in the US aren't staffed with full-time intensivist coverage. That being said, there are parts of NYC where GYN residents, PM&R residents, podiatrists and plastics PAs are caring for ICU patients with random anesthesiology, EM and IM attendings for oversight. It's pretty bad out here and definitely not optimal care in the least.

 

[deleted697535]

I've seen a woman arrest in a major icu from ventilator dyschrony 5 years ago, as programmed by an RT, and had a couple of ICU im resident looking at her.
She stopped coding when I popped off the circuit off tube.

Apparently she weirdly enough arrested at exactly the same time the night before also, which coincided with RT shift change.

So yes, anything can happen. Really quickly. Once resources are exhausted

 

[jeterfan]

sure it went on at many of the shops in the area. There was a period of about 10-15 days in late March/early April when queens, Brooklyn, bronx were completely overwhelmed.

Cuomo’s Response one day was to mandate hospitals double capacity Or they would be fined. The next day you had bsn nurses and very inexperienced people managing 4-5 intubated patients behind non telemetry monitored closed doors. Nurses from outpatient clinics were given 2 hours of instruction and then told to manage ventilated patients. Similar experience levels with residents.

I estimate 20-30 percent patients at least self extubated from improper sedation levels, or people not knowing how to work the pumps. Some self extubated..and
It was minutes before anyone knew followed by a soft code and expiring.

intubations early on especially involved rooms with no suction set up and having to suction thick secretions before any attempt. Had to use a forceps once.. thought i pulled out a tumor. How were these patients ever going to get better? Was it the nurses fault they were put in impossible situations and simply couldn’t deliver the time to really care for each patient? We wanted to divert. Were told the state would not allow it until we were 2x capacity.

was this the hospitals fault? Maybe ceo Should have said we will not deliver substandard care..and if fined so be it. Was it Cuomos fault for not understanding this is not a muffin factory..icu level care requires an incredible Amount of knowledge experience and training.

At some point there will be time for a more detailed analysis. He did waive a lot of the malpractice/liability requirements so maybe he knew lots of mistakes would happen.

in the end I think mandating a double of capacity was the wrong decision. Lots of hospitals an hour north/south/west And further in the sticks never came close to capacity. Diverting nyc patients to those hospitals would have afforded more to receive appropriate icu level care. I think most patients would have made the trip ok.

For now cases have fallen off. that period of mismatched level of care seems to be in the past..but for how long?? Until the fall when we have to deal with influenza as well?? hopefully there is a better thought out strategy in place by then. A strategy thought up by physicians..not politicians and bean counters.

Unfortunately though Lots of patients did die from inadequate or improper care. That’s just reality.

 

[dannyboy1]

Yup. Lots of $hitty care in NYC and suburbs that does not even approach ICU standard of care. I’m sure that won’t stop the hospital from sending out a bill for ICU level of care. This “doubling of ICU capacity “ is idiocy. It just can’t be done. It is just the illusion of care.....

 

[anbuitachi]

Is anyone here working at an NYC hospital? Are sick patients really being managed by non-intensivists (residents, off service attendings, midlevels, etc)? If so, patients may be better off at home and having their doula/chiropractor/midwife managing them (probably not to that extreme but you know what I mean). If hospitals aren’t able to meet standard of care (an ICU patient should have an intensivist and/or RT), should they be taking care of these patients?

they definitely are. especially at the peak. not enough ICU attendings. You go from having the standard ICUs to almost every floor becoming an ICU or have vented patients. Impossible to have the ICu attendings cover that many patients

 

[anbuitachi]

sure it went on at many of the shops in the area. There was a period of about 10-15 days in late March/early April when queens, Brooklyn, bronx were completely overwhelmed.

Cuomo’s Response one day was to mandate hospitals double capacity Or they would be fined. The next day you had bsn nurses and very inexperienced people managing 4-5 intubated patients behind non telemetry monitored closed doors. Nurses from outpatient clinics were given 2 hours of instruction and then told to manage ventilated patients. Similar experience levels with residents.

I estimate 20-30 percent patients at least self extubated from improper sedation levels, or people not knowing how to work the pumps. Some self extubated..and
It was minutes before anyone knew followed by a soft code and expiring.

intubations early on especially involved rooms with no suction set up and having to suction thick secretions before any attempt. Had to use a forceps once.. thought i pulled out a tumor. How were these patients ever going to get better? Was it the nurses fault they were put in impossible situations and simply couldn’t deliver the time to really care for each patient?

was this the hospitals fault? Cuomos fault? At some point there will be time for a more detailed analysis. He did waive a lot of the malpractice/liability requirements so maybe he knew lots of mistakes would happen.

in the end I think mandating a double of capacity was the wrong decision. Lots of hospitals an hour north/south/west And further never came close to capacity. Diverting nyc patients to those hospitals would have afforded more to receive appropriate icu level care. I think most patients would have made the trip ok.

Cases have fallen off. that period of mismatched level of care seems to be in the past...for now. Unfortunately though Lots of patients did die from inadequate or improper care. That’s just reality.

Yup. Lots of $hitty care in NYC and suburbs that does not even approach ICU standard of care. I’m sure that won’t stop the hospital from sending out a bill for ICU level of care. This “doubling of ICU capacity “ is idiocy. It just can’t be done. It is just the illusion of care.....

Peak times were disaster level situations. Sirens going on non stop. Everyone overwhelmed. Thats the whole point of the isolation, to decrease that to decrease mortality and improve care. When the system gets overwhelmed that quickly and that much, everything breaks down.

Im sure a lot of patients died sooner than they probably should have due to substandard care (compared to normal times), but this is a serious disease and adding on to the large volume of patients and its expected that care suffers.

There were many self extubations. Poor sedation management because the residents arent used to sedating people, and floor nurses arent used to care for sedated patients. Non monitored settings were changed to monitored beds overnight. Covid patients being taken care of on non negative rooms. Patients placed on bipap/cpap/high flow/non rebreather in the beginning bc no vents left. Doors left open because what are you supposed to do? doors dont even have windows yet its supposed to be the new ICU. Nurses starting sedation with 5mcg /kg/min of propofol, and slowly titrating up. Of course they are going to self extubate. Doctors were just running around putting out fires despite their lack of experience, while getting hammer paged in a situation often without good PPE. imagine that. that was nyc a few weeks ago

 

[chocomorsel]

Some vents are indeed confusing, they are all very different. He may just have put it on standby or off or on CPAP - there are many options. It is weird though there would be no alarms...

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It’s weird though that there is no RT or an RN. Are these family residents incubating patients on their own without any kind of assistance?
Makes no sense, but I guess if the system is overrun, and you have inexperienced staff all around, anything is possible.

 

[deleted171991]

They 100% are. That article is a POS. What does anybody expect a family resident to do when there are hundreds of ventilated patients and nobody to manage them. Flinging blame at them rather than the absurd response by everybody responsible in this country that put them in that situation. Absolute travesty. Poor resident probably feels absolutely putrid and 100% they were volunteering in trying to help.

I know for a fact that at major NYC institutions, non-anesthesia/IM residents are in charge of managing patients in the OR on anesthesia machines. With some supervisory oversight, but nothing that actually would meet any sort of standard. But what are you supposed to do when you have that many patients needing ventilators?

This is why I say that I am not afraid of Covid-19 as much as I am afraid of the doctors.

This is also why we should not intubate people, except as a last resort. An awake patient will "alarm" much earlier and more pertinently than a machine.

And this is also what happens with poor organization. These patients should be in the same big room, as in Italy. That way, any emergency has an ICU doc nearby.

 

[anbuitachi]

I also should add that at peak, we had MANY different types of vent, some looked like they are from decades ago. in fact, i had RT who didnt know how to use some of them without playing around.

i once asked RT to increase max allowed pressure bc it wasnt going above 35, and delivering very low volumes ... he didnt know how to do it bc its a different vent

 

[RT2DO]

You are aware of the situation in NYC? From the sound of your post, it doesn't seem as though that is so...

Absolutely, I am well aware of the situation in NYC, but I am also not there in person (so I probably have little idea!). I just was curious because that article made it sound like there is absolutely no safety net for the patients, when FM residents (who have no critical care training) have no attending coverage or even RTs/RNs to double check. I guess its bound to happen when the situation calls for all hands on deck, and the system is overwhelmed.
The article also seemed harsh on pointing at a resident and saying "the patient died because they dint know how to work a vent". You can't pinpoint at anyone when the situation looks like a mass casualty event. I was trying to give the resident the benefit of doubt here.

 

[anbuitachi]

Absolutely, I am well aware of the situation in NYC, but I am also not there in person (so I probably have little idea!). I just was curious because that article made it sound like there is absolutely no safety net for the patients, when FM residents (who have no critical care training) have no attending coverage or even RTs/RNs to double check. I guess its bound to happen when the situation calls for all hands on deck, and the system is overwhelmed.
The article also seemed harsh on pointing at a resident and saying "the patient died because they dint know how to work a vent". You can't pinpoint at anyone when the situation looks like a mass causality event. I was trying to give the resident the benefit of doubt here.

typical media blaming doctors

 

[kidthor]

Dying from a ventilator set "too high" is like dying from "too much anesthesia". Uninformed drivel by the press trying to paint us as stupid. They make it seem like all we do is turn a little wheel to medium - how could you get it wrong?

 

[deleted171991]

Dying from a ventilator set "too high" is like dying from "too much anesthesia". Uninformed drivel. All we do is turn a little wheel to medium - how could you get it wrong?

By not checking on it regularly. I have worked in many ICUs where, even at best of times, doctors don't check on their sick patients at least every 1-2 hours, and nurses every 15 minutes. As it should be.

I find it ridiculous that we provide OR anesthesia for much healthier patients with continuous patient supervision, but we don't invest in low patient/physician ratios in the ICU, just because the latter makes less money for the hospital. One of the reasons we need socialized healthcare for the essentials.

In an epidemic, all rules are out the window, I know. Still, even in normal times, most ICUs lack proper intensivist supervision.

 

[kidthor]

By not checking on it regularly. I have worked in many ICUs where, even at best of times, doctors don't check on their sick patients at least every 1-2 hours, and nurses every 15 minutes. As it should be.

I find it ridiculous that we provide OR anesthesia for much healthier patients with continuous patient supervision, but we don't invest in low patient/physician ratios in the ICU, just because the latter makes less money for the hospital. One of the reasons we need socialized healthcare for the essentials.

In an epidemic, all rules are out the window, I know. Still, even in normal times, most ICUs lack proper intensivist supervision.

Perhaps my sarcasm got lost - I meant that all these things are rather complicated and the press paints us all as stupid for not turning a dial to the right position. (I adjusted my post to be more sarcastically clear)



But agreed with your checking in point. I do find it surprising that ICU patients sometimes fester for a good long while without appropriate attention. Certainly those in NYC have been slammed beyond belief and they're doing the best they can - and they are heros.

 

[deleted171991]

Perhaps my sarcasm got lost - I meant that all these things are rather complicated and the press paints us all as stupid for not turning a dial to the right position.



But agreed with your checking in point. I do find it surprising that ICU patients sometimes fester for a good long while without appropriate attention. Certainly those in NYC have been slammed beyond belief and they're doing the best they can - and they are heros.

They are more than heroes, to me.

I am tired and sweaty even after 2 hours in the OR with a non-Covid patient. I can only imagine how being in the line of fire feels.

The a$$holes who run the hospitals should spend at least a couple of hours in the Covid ICU every day, instead of putting out bombastic corporate newsletters and interviews. Real generals and leaders don't hide behind the troops.

 

[jeterfan]

2 months ago any death in a non dnr patient would have been reviewed. Certainly a 52 y/o coding a couple hours after intubation would get dissected.

now most will be swept under the rug under the umbrella cause of “covid related” and long forgotten in a few weeks.

when causeof death is mistaken Judgement or error by a physician this place turns into a circus show. But when the cause is inadequate staff, equipment, improper care, abysmal training and other administrative causes..suddenly cmos and administrators are in radio silence. No one dare blame the big wigs or prince Cuomo.

 

[MoMoGesiologist]

How would you guys handle this if it was your family member as a patient in these hospitals where you cannot see or talk to them and very likely aren’t getting updates from the hospital staff? Why not transfer a large number out to suburban hospitals just to get staffing ratios better like someone else suggested in a prior post? If this was the situation, why not warn people to take their loved ones to another city?

Poor patients, poor family members... and they will never know what exactly happened to their loved ones in their final days/weeks... whether or not it was iatrogenic...

 

[Lexdiamondz]

How would you guys handle this if it was your family member as a patient in these hospitals where you cannot see or talk to them and very likely aren’t getting updates from the hospital staff? Why not transfer a large number out to suburban hospitals just to get staffing ratios better like someone else suggested in a prior post? If this was the situation, why not warn people to take their loved ones to another city?

Poor patients, poor family members... and they will never know what exactly happened to their loved ones in their final days/weeks... whether or not it was iatrogenic...

You’re assuming they’d survive long enough to go an hr outside the city- many of these guys showed up satting in the 60s on a NRB.

 

[deleted171991]

Yup, they are.



In all fairness, the majority of ICUs in the US aren't staffed with full-time intensivist coverage. That being said, there are parts of NYC where GYN residents, PM&R residents, podiatrists and plastics PAs are caring for ICU patients with random anesthesiology, EM and IM attendings for oversight. It's pretty bad out here and definitely not optimal care in the least.

Hey, but we've flattened the curve (by allowing anybody to practice at their maximum level of incompetence), right?

Victory! Just ask the White House.

 

[Hamhock]

I wonder if our professional societies should take some blame for this.

Although the media reported chaos in NYC and there were a few calls from CMOs at big name hospitals for intensivist help late in the storm, it seemed we didn't have a coordinated physician effort.

Intensivists were needed nationally but I know we were not all maxed out and perhaps we could have shared some reserves and saved lives. I wonder if the upstate NY intensivist groups, who were busy but not in a war zone-like environment, were aware that FM residents were managing patients on mechanical ventilation without supervision.

I sure am wishing I was there to help out -- even if it forced my partners to double efforts for my home community. [not practical from where I live, but I have that feeling anyway...]

HH

 

[deleted126335]

Almost Everybody is doing the best that they can with what they have. Fu(k those pieces of **** who second guess and Monday morning quarterback those that come up short for falling below the usual "standard" of care under normal circumstances.

 

[chocomorsel]

Well the first place I talked to offered me what they offer their full time employee hourly rate. $185 an hour.

 

[deleted171991]

Almost Everybody is doing the best that they can with what they have. Fu(k those pieces of **** who second guess and Monday morning quarterback those that come up short for falling below the usual "standard" of care under normal circumstances.

My favorite saying in this world: no good deed goes unpunished.

Every time I doubt it and myself, and go the extra mile, I just get more proof of its value. It's very sad, but humans are some truly ugly and ungrateful animals, deep inside.

Just look at all those landlords who kicked out healthcare "heroes" overnight, just for working in a Covid hospital. Nothing happened to those ****bags.

 

[VA Hopeful Dr]

My favorite saying in this world: no good deed goes unpunished.

Every time I doubt it and myself, and go the extra mile, I just get more proof of its value. It's very sad, but humans are some truly ugly and ungrateful animals, deep inside.

I feel like this should be added to the modified oath med students take these days.

 

[MoMoGesiologist]

Almost Everybody is doing the best that they can with what they have. Fu(k those pieces of **** who second guess and Monday morning quarterback those that come up short for falling below the usual "standard" of care under normal circumstances.

It’s a sad situation. I feel very bad for those FM residents and the story leaves so many questions: where was RT? The attending? Vent alarms? Or are we really saying things were so bad in NYC we put people not trained in charge of sick pts and just hoped for the best? I’m not trying to quarterback but these outcomes need to be investigated and followed up on. It’s not like someone got food poisoning at a restaurant, patients died and we need to know wth happened and how to do better for next time (nothing punitive)

 

[deleted171991]

It's unclear who set the ventilator. The original article had been posted on Business Insider, and has been corrected since.

A NYC coronavirus patient died after her ventilator was set too high under the care of inexperienced medical residents

The incident happened at the Montefiore Medical Center in the Bronx in March, The Wall Street Journal reported on Wednesday.

www.businessinsider.com

Editor's note: A previous version of this article stated that the medical residents set the patient's ventilator too high. It's unclear who set the ventilator.

 

[pjl]

Well the first place I talked to offered me what they offer their full time employee hourly rate. $185 an hour.

Terrible.

 

[D P356]

Clearly it says a family medicine doc, but I have a feeling this thread may wind up on social media saying “anesthesia residents don’t know how to work the vent in ICU.”

 

[anbuitachi]

Well the first place I talked to offered me what they offer their full time employee hourly rate. $185 an hour.

wow thats a lot more than what i get paid! lol!

 

[narcotics999]

wow thats a lot more than what i get paid! lol!

You need another job, ASAP!

 

[Nivens]

I read this as a wakeup call to those in medical education, because while it’s apparent this resident managed to secure a medical degree without knowing the reasonable range for PEEP, smart money says he aced his “humanities in medicine” course.

 

[chocomorsel]

I read this as a wakeup call to those in medical education, because while it’s apparent this resident managed to secure a medical degree without knowing the reasonable range for PEEP, smart money says he aced his “humanities in medicine” course.

I hope you are joking. This is a FM resident. I think they may have to do one month of ICU their whole residency.
And they don’t have to know how to run a vent.
And even for anesthesiologists who run ventilator in the OR daily, the ICU vents are not the same with also a different array of brands and setups.

 

[VA Hopeful Dr]

I hope you are joking. This is a FM resident. I think they may have to do one month of ICU their whole residency.
And they don’t have to know how to run a vent.
And even for anesthesiologists who run ventilator in the OR daily, the ICU vents are not the same with also a different array of brands and setups.

Either 1 month or I think 60 patients (for places with open-ICUs), so yeah there is no reason to expect us or our residents to know much about vents.

 

[Nivens]

I hope you are joking. This is a FM resident. I think they may have to do one month of ICU their whole residency.
And they don’t have to know how to run a vent.
And even for anesthesiologists who run ventilator in the OR daily, the ICU vents are not the same with also a different array of brands and setups.

Not joking even a little bit. I think it’s reasonable to expect anyone with “Dr” in front of their name to know what a reasonable PEEP value is, especially so close to graduation. If you’ve been out practicing FM in the community for thirty years, that’s a different story. And I’m not saying they should know how to titrate a vent or the differences between models, but to me this is the same as knowing CPR, how to place an IV/draw blood, read a CXR, interpret a CBC/chem panel/simple blood gas, take a history and perform a physical exam, and having a working knowledge of anatomy and physiology: basic doctor ****. One month in an ICU as a med student should be plenty for the level of knowledge I’m describing. I don’t need you to be able to explain to me the nuances of APRV, but you should know that a PEEP of 10 is reasonable and a PEEP of 80 is not. I’m not a surgeon but if someone handed me the EC and said “bovie to a million!” I’d know something wasn’t right.

My larger point is maybe we need to stop trying to turn every med student into a public health researcher/disparities expert/ethicist (there are plenty of grad degree programs for that important work) and make sure we’re getting the basics down.

 

[Nivens]

Redirect Notice

 

[Mad Jack]

Some vents are indeed confusing, they are all very different. He may just have put it on standby or off or on CPAP - there are many options. It is weird though there would be no alarms...

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The resident shouldn't be putting in settings on the vent regardless- there's a lot of nuance to using them and just dialing in settings without knowing the ins and outs of the machine can really screw things up. If they were just throwing in initial settings on a vent without a RT present that is terrifying.

 

[VA Hopeful Dr]

The resident shouldn't be putting in settings on the vent regardless- there's a lot of nuance to using them and just dialing in settings without knowing the ins and outs of the machine can really screw things up. If they were just throwing in initial settings on a vent without a RT present that is terrifying.

Interestingly in my state if you're not an RT you have to prove to the medical board that you're competent to manage a ventilator to adjust the settings on the machine without an RT present. This doesn't mean placing orders to change the settings but actually adjusting the settings on the machine yourself.

 

[Mad Jack]

Interestingly in my state if you're not an RT you have to prove to the medical board that you're competent to manage a ventilator to adjust the settings on the machine without an RT present. This doesn't mean placing orders to change the settings but actually adjusting the settings on the machine yourself.

I'm trying to figure out how this happened, as any competent RT would have caught obviously lethal settings and been like, no way I'm doing that. Either the resident did it alone or the RT was equally as clueless which seems doubtful

 

[VA Hopeful Dr]

Not joking even a little bit. I think it’s reasonable to expect anyone with “Dr” in front of their name to know what a reasonable PEEP value is, especially so close to graduation. If you’ve been out practicing FM in the community for thirty years, that’s a different story. And I’m not saying they should know how to titrate a vent or the differences between models, but to me this is the same as knowing CPR, how to place an IV/draw blood, read a CXR, interpret a CBC/chem panel/simple blood gas, take a history and perform a physical exam, and having a working knowledge of anatomy and physiology: basic doctor ****. One month in an ICU as a med student should be plenty for the level of knowledge I’m describing. I don’t need you to be able to explain to me the nuances of APRV, but you should know that a PEEP of 10 is reasonable and a PEEP of 80 is not. I’m not a surgeon but if someone handed me the EC and said “bovie to a million!” I’d know something wasn’t right.

My larger point is maybe we need to stop trying to turn every med student into a public health researcher/disparities expert/ethicist (there are plenty of grad degree programs for that important work) and make sure we’re getting the basics down.

Do we know exactly what happened in this case, like the settings that caused the death?

 

[MirrorTodd]

There is A LOT of information missing from that article. Drawing any sort of conclusions about it is worthless at this point. NONE of the other associated articles have any more information on this. The only thing we can really say is that the "swiss cheese" model of NYC must have some huge ****ing holes in it right now.