88 year old female who's g-tube was out approx. 14 hours
goes to ER. to have tube reinserted.
Has had tube for 5+ years after throat cancer operation and radiation.
In ER it was found that new tube would not go in due to stoma closure.
Taken to op. room to put tube in. Found that scope would not pass through narrowed esophagus (due to radiation scarring)
Patient goes into breathing distress,and flash pulmonary edma (almost requiring vent in icu.
Tube put in under local anasthesia, and small incision at site, (without scope) 3 days later
patient about to be dc,d after 8 days
Will need rehab. to recover her post hospital functions.
( idependant, living alone)
WHY: was scope method tried on a throat cancer patient with a radiation history (pt's voice is weak ,an indication of problems in the throat area,) also reading her chart and noting radiation to that area could have been a flag to expect trouble with passing a scope,
AS:all her problems stem from her reaction to the trauma
of the scope procedure.Why did this happen? Could this problem been avoided by the MD's alertness to this set of circumstances set in motion?
IN : the future would the non-scope method of insertion
be indicated for this type of patient?
Does lack of experience on the MD's part account for the
decison made and it's negative concequenses for the patient?
Is this what medical "practice" means.