Emergency/Legal Issues

[WINDYLYNDA]

Hi,

I am a nursing student and just want to get a general consensus here.

The hypothetical question is:

Semiconscious patient with foreign body in throat is admitted to the ER. There is no MD present, but stat request goes out for the on-call doc. Without waiting, nurse decides to remove foreign body which is unsuccessful. Due to increasing cyanosis, said nurse decides to perform a tracheotomy which opens air passage and keeps patient alive until the doc gets there.

When would this be an acceptable procedure?

How flagrant would this behavior be: A) Proper under the circumstances; B) Nurse needs revocation of RN license, C) Malpractice suit being brought by patient.

I feel this is not a warranted action by the nurse because it exceeds her authority and the patient was still semiconcious but... how do all of you feel?

Windylynda:balloons:

[danh3190]

I suppose if the procedure went perfectly and the patient was saved he'd have trouble winning since in a lawsuit he would have to prove that he was harmed. I guess if he wanted to cause problems he could complain to the state BON.

I've not seen tracheostomies done but our former medical director (a surgeon) said a real trach isn't that easy. Big chance of hemorrhage from the thyroid etc.

Your respiratory therapists or a paramedic would have a decent chance at removing the obstruction by visualizing the airway with a laryngoscope and using magill forceps to pull out the obstruction. If all else failed they could try going in through the cricothyroid membrane either with a needle or scalpel and tube. I know paramedics are trained in that procedure. Don't know about respiratory therapists or other licenced medical workers.