This is an interesting read if you haven't seen it before.

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The part that hits home the most for me is that there will always be some "colleague" lining up to take plaintiffs money to stab you in the back.

Someone should secret cam that Dr. Ferris's inductions (if they're even clinical anymore) to see if they induce with 40mg propofol boluses every few seconds.....

But, as far as medicolegally, I suspect the anesthesiologist loses because of the zofran.
 
The whole Zofran thing is kinda goofy. Should be easy to interrogate the monitor and see if there was an R on T/Torsades episode or if this was simply apnea/obstruction-->hypoxia-->arrest (which is infinitely more likely). But, who gives Zofran before a propofol EGD anyways?The comments about overdosing sux are stupid too. Blame Joan Rivers on not having sux but then implicate it in this case when it was given appropriately?? OK guy 😕.

Very nice to see an article highlighting our importance though. Also makes me happy to practice MD only.
 
I feel for the patient. Bariatric endoscopy can be difficult I topicolize give 25 of fent 1 midazolam topicolize with lidocaine and 20-30 of propofol and they don't cough and not aware no coughing or moving and they respond when asked to squeeze my hand. At the end they wake up. I do my own cases.
 
narcusprince said:
I feel for the patient. Bariatric endoscopy can be difficult I topicolize give 25 of fent 1 midazolam topicolize with lidocaine and 20-30 of propofol and they don't cough and not aware no coughing or moving and they respond when asked to squeeze my hand. At the end they wake up. I do my own cases.
Click to expand...

What do you "topicolize" with?
 
This is a very simple straight forward airway obstruction/failed intubation/ lack of judgement cluster of disasters. The Zofran and arrhythmia theory is very stupid but the defense attorney could use it to decrease the liability of the CRNA and Anesthesiologist.
 
Planktonmd said:
This is a very simple straight forward airway obstruction/failed intubation/ lack of judgement cluster of disasters. The Zofran and arrhythmia theory is very stupid but the defense attorney could use it to decrease the liability of the CRNA and Anesthesiologist.
Click to expand...

How could the defense attorney use that to their advantage? If you've got an EKG with long qT and then give Zofran I think that would work against you.
 
Sadly, I think that zofran works against the anesthesiologist here. Known prolonged QT patient, black box warning on drug --->settlement or jury doing the layman math and deciding that zofran did it.

But I agree, why give zofran to a propofol sedation at all? Little lone when they have prolonged QT, just medicolegal risk with little to no need/benefit.
 
Their first mistake was to not inform the patient that the anesthesiologist was only supervising. I think most patients would want to know the level of involvement of the anesthesiologist. It can be misleading when the anesthesiologist comes in pre-op and never mentions anything about a CRNA and/or other anesthesiologists being involved, and the CRNA doesn't come in to introduce themselves. Patients are understandably going to assume that that anesthesiologist is the one taking care of them. The only thing worse than something going wrong is having something go wrong while the family and/or patient feel like they were deceived. That's not going to end well.

I live in Houston, and so far it's not been a problem for me to request anesthesiologist only. In fact, I had surgery at Memorial Hermann (not Southeast, another location) and they accommodated my request (made in advance) for an anesthesiologist.
 
My favorite part, that always seems to show up in these articles, was the nonsense about biting so hard she broke her teeth. I think we all know why pieces of her teeth were on the floor ...

Otherwise, much better article than we usually see on this subject.

And F that expert witness. ABA should revoke her board certification.
 
HIPAAHasOneP said:
Their first mistake was to not inform the patient that the anesthesiologist was only supervising.
Click to expand...
The article said that was disclosed on the consent.

Who knows what was actually spoken and heard and understood, but the patient signed a consent form for an ACT anesthetic.
 
I always read the comments and the noctors are typically so indignant and nauseating.
 
SaltyDog said:
How could the defense attorney use that to their advantage? If you've got an EKG with long qT and then give Zofran I think that would work against you.
Click to expand...
You are right... it's actually in favor of the plaintiff, I didn't read the whole thing.
But in reality I don't think it had any role and that magical response to Magnesium is nothing but a coincidence.
 
Playing devils advocate.

Their are endo deaths but no correlation when it comes to MD only model (Joan Rivers).

Crna only model (https://forums.studentdoctor.net/th...he-gi-suite-patients-family-sues-crna.732109/)

Or in this case ACT model.

If there are more anesthesia related deaths we could collect samples. However no one will run or find a double blind study with new grad fresh from srna school or new grad fresh from anesthesiology residency involving similar ASA 4.5 patients

That study would be the gold standard to prove safety. I'll ask the AANA past and current board of directors have their super sick family member sign up with this study. They should be the first to sign up. Only high risk patients with high risk surgeries.
 
GravelRider said:
Why did the author feel the need to point out that the anesthesiologist is a pro-life activist and doesn't trust doctors to make ethical decisions?
Click to expand...

She probably googled her and that's all they found.
The zofran probably had nothing to do with the airway misadventure and arrest, but the jury won't see it that way. I don't give zofran to long QT patients. That wasn't smart.


--
Il Destriero
 
pgg said:
The article said that was disclosed on the consent.

Who knows what was actually spoken and heard and understood, but the patient signed a consent form for an ACT anesthetic.
Click to expand...

You're right. I missed that part in the article. I'm probably one of the few people who actually reads the forms I sign, and I don't recall that being in the consent I signed last year at Memorial Hermann. That doesn't mean it's not in there. Now, I'm curious. I'm going to see if I can find it and see what it says. Even if it's stuck in the consent somewhere it's probably wise to still mention it, because you don't want patients and/or their families feeling like they were mislead. They will be the ones who sue.

Update:
I located the ICD I signed in 2016 at Memorial Hermann (a different location than the one in the story). Not sure if this is the same document she signed, but this is what it says:

"I understand that the anesthesiologist(s) may be assisted by an anesthetist who also is not an employee of the hospital."

The statement is in the middle of a long paragraph that talks about a lot of different things. I think they should really re-think what they're telling patients. They make it sound like the anesthetist is just helping out, which sounds like they have a minor role. What the consent should say is something that indicates the anesthetist is the one administering the anesthesia/caring for the patient under supervision of an anesthesiologist(s) and that the anesthesiologist will not be present the entire time. That would be closer to informed consent.
 
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pgg said:
My favorite part, that always seems to show up in these articles, was the nonsense about biting so hard she broke her teeth. I think we all know why pieces of her teeth were on the floor ...

Otherwise, much better article than we usually see on this subject.

And F that expert witness. ABA should revoke her board certification.
Click to expand...
Yup, nurse probably fractured her teeth during intubation well before trismus even set in.
 
DrOwnage said:
The zofran argument is stupid. I bet her QTc was shy above 440. Last time I checked the literature, the dose of Zofran needed to significantly prolong the QT is like over 30mg.
Click to expand...

I'm not sure that's true though I 100% agree with the likely lack of any prolongation of clinical significance with 4 or 8mg. The lawyer and jury significance is much much greater than the clinical significance here. Best to just avoid.
 
First of all, I never give zofran for endoscopies. Secondly it sounds like too much time wasted trying to intubate when an LMA would have done the trick whether or not succinylcholine or more propofol was needed to make that happen.
 
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Also we do need to consider the skill set of the endoscopist. Slow endoscopist = dangerous endoscopist. Our bariatric endoscopies take less then 5 minutes. I joke with our guys that they put just the tip in.
 
Outrigger said:
First of all, I never give zofran for endoscopies. Secondly it sounds like too much time wasted trying to inbuate when an LMA would have done the trick whether or not succinylcholine or more propofol was needed to make that happen.
Click to expand...
The whole situation was obviously a major cluster F*** with people panicking and running around like chickens with their heads cut off.
 
narcusprince said:
Also we do need to consider the skill set of the endoscopist. Slow endoscopist = dangerous endoscopist. Our bariatric endoscopies take less then 5 minutes. I joke with our guys that they put just the tip in.
Click to expand...
I'm not sure I follow this or believe it.
I assume you are talking about upper endoscopes alone. But that still isn't someone I want doing my scope.
 
Article is too long. It sums up to too much propofol for the level of stimulatiom given at that point, which in itself is pretty routine event, complicated by lack of skills needed to get out of trouble in a timely manner. The zofran is just a diversion.

I serously doubt that a morbidly obese person has only 1/100 thousand chance of a bad outcome. I would say closer to 1/ 1 thousand. Maybe even higher than that.
 
urge said:
Article is too long. It sums up to too much propofol for the level of stimulatiom given at that point, which in itself is pretty routine event, complicated by lack of skills needed to get out of trouble in a timely manner. The zofran is just a diversion.

I serously doubt that a morbidly obese person has only 1/100 thousand chance of a bad outcome. I would say closer to 1/ 1 thousand. Maybe even higher than that.
Click to expand...

She was deemed well enough for the endoscope. That means she was 100% healthy of course.
 
Noyac said:
I'm not sure I follow this or believe it.
I assume you are talking about upper endoscopes alone. But that still isn't someone I want doing my scope.
Click to expand...
My understanding is with the bariatric upper endoscopies they look for a haital hernia because it alters surgical approach. This takes 5 minutes.
 
narcusprince said:
Also we do need to consider the skill set of the endoscopist. Slow endoscopist = dangerous endoscopist. Our bariatric endoscopies take less then 5 minutes. I joke with our guys that they put just the tip in.
Click to expand...
When I joke about just putting the tip in all I get is dirty looks
 
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