Versed and vecuronium. Not the same thing.

Discussion in 'Emergency Medicine' started by Dr Mantis Toboggan, Nov 30, 2018.

  1. Dr Mantis Toboggan

    Physician Faculty 2+ Year Member

    Joined:
    Feb 4, 2017
    Messages:
    132
    Likes Received:
    175
    Status:
    Attending Physician
  2. Hamhock

    7+ Year Member

    Joined:
    May 6, 2009
    Messages:
    1,126
    Likes Received:
    334
    Status:
    Attending Physician
    I know we often laugh at the press for making obvious mistakes reporting medicine.

    However, this "journal" is called "Modern Healthcare" and yet this quote is from the middle of the very short article"

    "...but a nurse accidentally delivered vecuronium, an anesthetic."

    Does even a healthcare publication not have it's articles reviewed for a bit of accuracy!

    HH
     
    witzelsucht likes this.
  3. OP
    OP
    Dr Mantis Toboggan

    Physician Faculty 2+ Year Member

    Joined:
    Feb 4, 2017
    Messages:
    132
    Likes Received:
    175
    Status:
    Attending Physician
    Yeah sadly it was not an anesthetic. Would’ve made the death at least more pleasant.


     
    Gurby and TimesNewRoman like this.
  4. nimbus

    nimbus Member
    10+ Year Member

    Joined:
    Jan 14, 2006
    Messages:
    3,536
    Likes Received:
    3,173
    They both “relax” you. Same error was made many years ago at my training institution by the medicine team doing an LP with the same outcome for the patient.
     
  5. dpmd

    dpmd Relaxing
    Physician 10+ Year Member

    Joined:
    Sep 14, 2006
    Messages:
    19,531
    Likes Received:
    28,330
    Status:
    Attending Physician
    From a different source
    "We don’t know,” an unidentified Vanderbilt official told investigators, according to the report. “(The patient) got such a small dose, and he/she was anxious about the test, so we can’t say it contributed to his/her demise.”
    :uhno:
     
    TimesNewRoman likes this.
  6. GonnaBeADoc2222

    10+ Year Member

    Joined:
    Oct 31, 2008
    Messages:
    515
    Likes Received:
    656
    Status:
    Attending Physician
    Not a good look for Vandy.
     
  7. turkeyjerky

    Physician 10+ Year Member

    Joined:
    Sep 27, 2008
    Messages:
    1,760
    Likes Received:
    142
    Status:
    Resident [Any Field]
    Stfu. A doctor made that mistake? I would think more likely the wrong Med was taken from the Pyxis Edit--which us exactly what happened in this case, so I guess same thing.

    Partial solution--only use generic drug names?
     
    #7 turkeyjerky, Nov 30, 2018
    Last edited: Nov 30, 2018
  8. alphaholic06

    alphaholic06 Doctor, Who? Me?
    Physician 15+ Year Member

    Joined:
    Jan 14, 2004
    Messages:
    871
    Likes Received:
    25
    Status:
    Attending Physician
    No it was a nurse.

    Sent from my SM-T830 using SDN mobile
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  9. wholeheartedly

    Staff Member Administrator Verified Expert 7+ Year Member

    Joined:
    Aug 8, 2009
    Messages:
    5,229
    Likes Received:
    3,236
    I believe he was referring to nimbus's story
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
    nimbus likes this.
  10. Birdstrike

    7+ Year Member

    Joined:
    Dec 19, 2010
    Messages:
    4,844
    Likes Received:
    3,725
    An in neither case were those involved apparently able to recognize the resultant apnea and treat it. Even in such a medication error, prompt recognition, intubation and supportive care, until the medication wears off, would not only saved the patient, but without permanent harm. Unfortunate.
     
    lymphocyte and nimbus like this.
  11. WheezyBaby

    WheezyBaby RSV Fomite
    Physician 2+ Year Member

    Joined:
    Jun 9, 2016
    Messages:
    599
    Likes Received:
    1,027
    Status:
    Resident [Any Field]
    What a horrible way to die
     
    filhodeinferno and TimesNewRoman like this.
  12. alphaholic06

    alphaholic06 Doctor, Who? Me?
    Physician 15+ Year Member

    Joined:
    Jan 14, 2004
    Messages:
    871
    Likes Received:
    25
    Status:
    Attending Physician
    If CMS pulls their funding, does that include GME funding for their residency programs?

    Sent from my SM-T830 using SDN mobile
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
    hushhush88 likes this.
  13. Hamhock

    7+ Year Member

    Joined:
    May 6, 2009
    Messages:
    1,126
    Likes Received:
    334
    Status:
    Attending Physician
    Vandy is not going to loose Medicare funding for these mistakes (vec instead of versed; cover-up)...unless there are absolutely no safety mechanisms and they refuse to put them in place.

    I wouldn't worry for second if I was a trainee about my program falling apart.

    HH
     
  14. nimbus

    nimbus Member
    10+ Year Member

    Joined:
    Jan 14, 2006
    Messages:
    3,536
    Likes Received:
    3,173

    Correct. They will just need to put giant “PARALYZING AGENT” labels on all vials of NMB’s and all will be forgiven.
     
  15. nimbus

    nimbus Member
    10+ Year Member

    Joined:
    Jan 14, 2006
    Messages:
    3,536
    Likes Received:
    3,173

    It was a medicine resident who didn’t understand that “muscle relaxants” cause paralysis. It was mechanism of action confusion, not name confusion.
     
    hushhush88 and wholeheartedly like this.
  16. southerndoc

    southerndoc life is good
    Physician Faculty Moderator Emeritus Lifetime Donor Verified Expert Verified Account 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,796
    Likes Received:
    712
    Status:
    Attending Physician
    Highly unlikely. CMS frequently gives notice of removing funding (sometimes a fast track 7-day notice) that they almost always reverse after an action is corrected or measures are put in place to prevent them from occurring again.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  17. Vandalia

    5+ Year Member

    Joined:
    Feb 21, 2014
    Messages:
    521
    Likes Received:
    699
    Status:
    Attending Physician
    Very true. If every institution that received a letter was barred from participation, I doubt there would be a hospital left that took Medicare.
     
  18. WheezyBaby

    WheezyBaby RSV Fomite
    Physician 2+ Year Member

    Joined:
    Jun 9, 2016
    Messages:
    599
    Likes Received:
    1,027
    Status:
    Resident [Any Field]
    FFS
     
  19. alphaholic06

    alphaholic06 Doctor, Who? Me?
    Physician 15+ Year Member

    Joined:
    Jan 14, 2004
    Messages:
    871
    Likes Received:
    25
    Status:
    Attending Physician
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  20. Vandalia

    5+ Year Member

    Joined:
    Feb 21, 2014
    Messages:
    521
    Likes Received:
    699
    Status:
    Attending Physician
    It almost sounds to me that the relevant attending physician was not told about the medication mistake. Either the physician was made to believe that the patient was given versed and somehow stopped after that, or the physician was putting himself in serious jeopardy to cover for a nurse in a completely different department...I am going with the former.
     
  21. OP
    OP
    Dr Mantis Toboggan

    Physician Faculty 2+ Year Member

    Joined:
    Feb 4, 2017
    Messages:
    132
    Likes Received:
    175
    Status:
    Attending Physician
  22. OP
    OP
    Dr Mantis Toboggan

    Physician Faculty 2+ Year Member

    Joined:
    Feb 4, 2017
    Messages:
    132
    Likes Received:
    175
    Status:
    Attending Physician
    Vandy’s just too big to fail.


     
    TimesNewRoman likes this.
  23. nimbus

    nimbus Member
    10+ Year Member

    Joined:
    Jan 14, 2006
    Messages:
    3,536
    Likes Received:
    3,173

    “In this case, the drug appears to have caused the patient, who was otherwise stable, to lose consciousness, suffer cardiac arrest and ultimately be left brain dead. The patient died one day later after being taken off of a breathing machine.”

    That news article incorrectly calls vecuronium an “anesthetic” and states that vecuronium causes unconsciousness, almost repeating the error of the nurse. If only that was true. The nurse gave an anxious, claustrophobic patient a paralyzing agent and no sedatives. I feel bad for that patient. Hopefully they became unconscious quickly from hypoxia and hypercarbia.
     
    #23 nimbus, Dec 1, 2018
    Last edited: Dec 1, 2018
    hushhush88, PhillyMed777 and Gurby like this.
  24. Vandalia

    5+ Year Member

    Joined:
    Feb 21, 2014
    Messages:
    521
    Likes Received:
    699
    Status:
    Attending Physician
    I don't see much egregious in that from a lay person.

    Vecuronium is used almost exclusively in conjunction with anesthesia, so lumping it in as an "anesthetic" is not that significant of a mistake from a reporter, and I can guarantee you that if vecuronium is injected in a patient, they will shortly be unconscious... in one way or another.
     
  25. filhodeinferno

    7+ Year Member

    Joined:
    Mar 22, 2009
    Messages:
    372
    Likes Received:
    182
    Status:
    Resident [Any Field]
    That's what I was thinking. Can't imagine much worse than being completely awake and lucid but paralyzed while you slowly suffocate to death because you can't take a breath. All the while everyone around you just goes about their business for the first 1 or 2 minutes before you lose consciousness.
     
    nimbus likes this.
  26. southerndoc

    southerndoc life is good
    Physician Faculty Moderator Emeritus Lifetime Donor Verified Expert Verified Account 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,796
    Likes Received:
    712
    Status:
    Attending Physician
    I find it appalling that their spokesperson keeps saying that only a small dose was given of the vecuronium. Whether it's 10 mg or 1 mg, vecuronium is a paralytic, and many patients will have enough paralysis with a small dose that it can cause death.

    Hopefully Vandy publishes what they do to prevent this in the future. We all should learn from this. This could have happened at any hospital in the nation. When I was a resident, we had a pregnant patient get succinylcholine instead of morphine because a paramedic drew both up and got the syringes mixed up. Luckily it was caught early. (There was another patient next room who was getting RSI'd; he accidentally pushed the leftover succinylcholine instead of the morphine).

    We have a policy in my ER where even if the nurse draws it up and gives it immediately, all syringes must be labeled with etomidate, succinylcholine, rocuronium, etc. We have preprinted stickers in our RSI box.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  27. dpmd

    dpmd Relaxing
    Physician 10+ Year Member

    Joined:
    Sep 14, 2006
    Messages:
    19,531
    Likes Received:
    28,330
    Status:
    Attending Physician
    This is where I would bet my money
     
  28. GonnaBeADoc2222

    10+ Year Member

    Joined:
    Oct 31, 2008
    Messages:
    515
    Likes Received:
    656
    Status:
    Attending Physician
    How it's not a policy to label syringes is beyond me. Not only should this be a policy, it's just common sense.
     
    scummie, njac and jl lin like this.
  29. Psai

    Psai This space for lease
    Removed 5+ Year Member

    Joined:
    Jan 2, 2014
    Messages:
    11,524
    Likes Received:
    23,410
    Status:
    Resident [Any Field]
    I wonder if 1 mg would be significant enough to cause respiratory depression. I think it wouldn't affect the patient much aside from mild weakness although 10 mg is a different story.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  30. southerndoc

    southerndoc life is good
    Physician Faculty Moderator Emeritus Lifetime Donor Verified Expert Verified Account 10+ Year Member

    Joined:
    Jun 6, 2002
    Messages:
    11,796
    Likes Received:
    712
    Status:
    Attending Physician
    Maybe not an average person, but a little old lady that might weigh 50-60 kg, it very well could be a paralyzing dose or cause enough difficulty with respirations to cause arrest. Total paralysis isn't required. If you paralyze enough and cause respiratory insufficiency, that can eventually cause respiratory arrest.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  31. Vandalia

    5+ Year Member

    Joined:
    Feb 21, 2014
    Messages:
    521
    Likes Received:
    699
    Status:
    Attending Physician
    There was a nurse who injected her husband with rocuronium and then set the house on fire around him. That would be worse, but I agree it is hard to get much worse than the case in this thread.

    Michael guilty of murder, arson
     
  32. jl lin

    7+ Year Member

    Joined:
    Oct 9, 2009
    Messages:
    5,084
    Likes Received:
    1,252
    How the hell does a nursing working in such an area not know the difference between versed and vecuronium? Speechless.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  33. Vandalia

    5+ Year Member

    Joined:
    Feb 21, 2014
    Messages:
    521
    Likes Received:
    699
    Status:
    Attending Physician
    Why did I leave the remote control in the refrigerator once? Not paying attention.

    I am certain she knew the difference between the two, but was likely working on autopilot.
     
    DeadCactus, gamerEMdoc and WilcoWorld like this.
  34. WilcoWorld

    WilcoWorld Senior Member
    10+ Year Member

    Joined:
    Nov 2, 2004
    Messages:
    2,968
    Likes Received:
    1,646
    Yep, the surest way to repeat someone else's mistake is to assume that we're incapable of doing so.
     
    jessasaurus, DeadCactus, njac and 4 others like this.
  35. jl lin

    7+ Year Member

    Joined:
    Oct 9, 2009
    Messages:
    5,084
    Likes Received:
    1,252
    Maybe it's from working in so much critical care and peds. Everyone makes mistakes. I sure have; but I have never confused one so significantly different agent from another and then given 5 times the dosage.

    Speaking of autopilot...I was watching the Weather Channel. They had a show about what caused a number of commercial airplanes to crash. Interestingly enough, autopilot mode was a factor in a number of them. Computers and technology can't totally top the living, functioning brain.

    P.S. Healthy fear has served me well over the years.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  36. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO.
    10+ Year Member

    Joined:
    Aug 21, 2007
    Messages:
    3,744
    Likes Received:
    2,976
    Status:
    Attending Physician
    Thank Christ I'm not the only one who has done this.

    In a similar vein, I put the hose in the hot tub to fill it up and then went grocery shopping/to the bank/post office.
    8 hours later...
    My cat is meowing at the sliding glass door that goes out to the lanai, wondering why it looks like a fishtank.
    Water bill = 250 or so dollars. Thank you, please drive thru.
     
    nimbus and gamerEMdoc like this.
  37. Birdstrike

    7+ Year Member

    Joined:
    Dec 19, 2010
    Messages:
    4,844
    Likes Received:
    3,725
    And since the patient was being "sedated," during which hypoxia and apnea are always a known risk, was the patient monitored, and if not, why not? If so, why was the hypoxia and apnea not promptly dealt with? Was the team performing the sedation not equipped to handle the side effects of a patient apneic from sedation, whether from a paralytic, benzodiazepine or an opiate?
     
    nimbus likes this.
  38. WilcoWorld

    WilcoWorld Senior Member
    10+ Year Member

    Joined:
    Nov 2, 2004
    Messages:
    2,968
    Likes Received:
    1,646
    My guess is that they were probably treating it as anxiolysis, rather than sedation.

    That said, if you push 10mg of IV versed, don't lie to yourself - you're aiming for sedation.
     
    #38 WilcoWorld, Dec 2, 2018
    Last edited: Dec 2, 2018
  39. Birdstrike

    7+ Year Member

    Joined:
    Dec 19, 2010
    Messages:
    4,844
    Likes Received:
    3,725
    Exactly. You shouldn't be pushing anything like versed, regardless of what you're calling it, without being confident you can breathe for the patient if necessary.
     
  40. thegenius

    thegenius Senior Wharf Rat
    10+ Year Member

    Joined:
    Jul 12, 2004
    Messages:
    1,224
    Likes Received:
    302
    Status:
    Attending Physician
    Yea and if I even draw up push dose pressors in a syringe and I keep the syringe on me at all times, I still label it. I get some tape and label what it is with the concentration. A must do.
     
    RustedFox likes this.
  41. HLxDrummer

    7+ Year Member

    Joined:
    Nov 20, 2011
    Messages:
    251
    Likes Received:
    98
    Status:
    Medical Student
    "I can't seem to get this CT angiogram bolus timed correctly..."
     
  42. TimesNewRoman

    5+ Year Member

    Joined:
    May 14, 2013
    Messages:
    2,295
    Likes Received:
    1,940
    Status:
    Attending Physician
    We usually just tape the vial of whatever we’re pulling up to the syringe.
     
    thegenius likes this.
  43. Vandalia

    5+ Year Member

    Joined:
    Feb 21, 2014
    Messages:
    521
    Likes Received:
    699
    Status:
    Attending Physician
    I found the CMS report. It nails down all the details. If you don't want a recital of "nursing standard of care", go to page 7.

    CMS Report

    There are some details that were reported/assumed that were incorrect. It is also a classic case of how these things can go badly wrong as everyone was "busy" and everyone assumed that someone else was taking care of the necessary tasks. (See page 23.)

    See page 52 for physician/NP notes.
     
    #43 Vandalia, Dec 3, 2018
    Last edited: Dec 3, 2018
    sunshinefl likes this.
  44. turkeyjerky

    Physician 10+ Year Member

    Joined:
    Sep 27, 2008
    Messages:
    1,760
    Likes Received:
    142
    Status:
    Resident [Any Field]
    Makes sense--pretty much what I figured happened. I doubt firing that nurse made anyone safer
     
  45. WilcoWorld

    WilcoWorld Senior Member
    10+ Year Member

    Joined:
    Nov 2, 2004
    Messages:
    2,968
    Likes Received:
    1,646
    Agreed. I wonder how many times that same RN has had to use an override function to give good timely care? Probably a lot.

    I have to click through so many safety warnings* in any given shift that it takes a Guru's level of self-awareness to not completely ignore such things.

    Firing a nurse and adding mindless safety alerts will not make patients safer. Adding staffing and worrying less about "an excellent experience, every time (TM)" would do a lot more.

    *Examples include warnings when I order maintenance fluids on someone who has received a bolus, chose ceftriaxone for someone with a reported mild penicillin allergy, give a heparin loading dose to someone I'm also starting on a heparin drip...
     
    wholeheartedly and nimbus like this.
  46. Vandalia

    5+ Year Member

    Joined:
    Feb 21, 2014
    Messages:
    521
    Likes Received:
    699
    Status:
    Attending Physician
    Sometimes, in my crazier moments, I have considered buying a couple hundred copies of "The Boy Who Cries Wolf" and giving them to our pharmacy and nursing administration, as well as officials at the JCAHO, CMS, etc., etc.

    The one thing stopping me is that I know they would not make the connection.
     
  47. BoardingDoc

    BoardingDoc Don't worry. I've got my towel.
    Physician 7+ Year Member

    Joined:
    Feb 23, 2010
    Messages:
    1,105
    Likes Received:
    1,563
    Status:
    Attending Physician
    Or any degree of allergy for that matter since there is no associated cross reactivity between pcn and 3rd gen cephalosporins.
     
    nimbus likes this.
  48. alphaholic06

    alphaholic06 Doctor, Who? Me?
    Physician 15+ Year Member

    Joined:
    Jan 14, 2004
    Messages:
    871
    Likes Received:
    25
    Status:
    Attending Physician
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  49. Psai

    Psai This space for lease
    Removed 5+ Year Member

    Joined:
    Jan 2, 2014
    Messages:
    11,524
    Likes Received:
    23,410
    Status:
    Resident [Any Field]
    Why do we need sedation in the scanner in the first place? Our country is full of namby pambys.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  50. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
    Moderator Physician Faculty Verified Expert 10+ Year Member

    Joined:
    Aug 2, 2006
    Messages:
    9,671
    Likes Received:
    5,871
    Status:
    Attending Physician

Share This Page