Emergency/Legal Issues

  1. 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?
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  3. by   RN1989
    This is not within scope of practice. Unlikely an ER would not have a doc present. Pt likely to bring a suit against nurse even if outcome good due to danger to pt r/t nurse not formally trained for this. Nurse likely to lose job if not license. Other ways of keeping pt alive possible.
  4. by   WINDYLYNDA
    What other ways of keeping the pt alive are you referring to?
    Thanks for the input.

  5. by   leslie :-D
    i remember when i was taking nutrition, my instructor got sidetracked about a patron in a restaurant, getting food lodged in his throat- he lost consciousness.

    repeated heimlichs, to no avail.

    an emt (another patron), performed an emergency tracheotomy and pt was whisked away minutes later.

    this instructor told us how to perform said tracheotomy (slit between 3rd-4th cricoid cartilage), insert straw.

    would this fall under good samaritan act?

  6. by   Katnip
    If you're a licensed professional it would not likely fall under the Good Samaritan act since you're still operating outside the scope of practice. Professionals are still held to a somewhat higher standard than a lay person.

    If the patient had died, or something was done wrong and caused harm, the patient or family can sue. I worked with a doc once who did a roadside trach on a man who had totally lost his airway and EMS couldn't help him. The incision got infected and the hospital didn't address it well, and the man had difficulty with his voice for the rest of his life. No brain damage or anything, just vocal cord problems. The man successfully sued the doctor who saved his life, EMS, and the hospital, so be careful about Good Sam. Most people are grateful to still be alive but there are those out there who can and will sue if the outcome is not to their satisfaction, no matter how well you did.
  7. by   EmmaG
    Quote from cyberkat
    the man had difficulty with his voice for the rest of his life. No brain damage or anything, just vocal cord problems. The man successfully sued the doctor who saved his life, EMS, and the hospital, so be careful about Good Sam.
    Stuff like this just ticks me off. If this was award by jury, they should each be smacked.
  8. by   TexasPediRN
    One of my nursing instructors in school told us a story about 2 nurses who saved a mans life by inserting a makeshift tracheostomy.

    Apparently, the man tried to sue for 'practicing outside the scope of practice'. The judge threw the case out and pretty much told the man that he had some nerve suing the nurses who saved his life.
  9. by   hospitalstaph
    I cannot imagine a situation when the doctor would be away from the ER.

    However, unless you have specific training in performing such procedures, you have no business doing them. Yes the patient "may" die, but the hospital would be responsible for not having a doctor in the ER. Or the ER doctor would be responsible for "stepping away" for a bit. Either way, you are not on the hook.

    It may sound heroic and wonderful to perform this act that saves a pts life, but how would you feel if it went wrong? What if it ended up not being quite so easy, and you were not prepared to handle the complications?

    The scope of practice exists for a reason.

    Hope this helps
  10. by   Noryn
    These are usually rare but difficult situations. If they are unable to cough, speak or move any air then the first think to attempt is the heimlich. The good samaritan act varies by state, for instance in my state it does not cover me while I am at work or for work in my profession. I also dont understand how you can have only a RN in an ER. They cannot diagnose, if 1 patient comes in then there has to be a doctor.

    Generally speaking this is not within the nurse's scope of practice however when you take ACLS you are (or at least I was) trained in how to do this. The sad reality today is that if a nurse did perform this they would likely be sued or have action taken against their license. Kind of sad perhaps the "right answer" is to not perform a procedure you have been trained to do and let the patient die.
  11. by   TazziRN
    I worked in two different ERs, one rural and one large town-small city. At the larger one, the docs worked 12's and were often off the unit in the lounge when there was nothing for them to do for the moment. They were reachable.

    At the rural one, the docs work 24's. The sleep room is down the hall from the ER. Pages cannot be heard in there. They could be in the bathroom or taking a shower. There have been occasions (rare, thank God) that I couldn't find the ER doc and ended up paging "Any physician to ER, STAT!"
  12. by   Katnip
    Quote from Emmanuel Goldstein
    Stuff like this just ticks me off. If this was award by jury, they should each be smacked.
    It was a jury. And I could understand a reasonable settlement if the man made his living with his voice like a singer or DJ or something. But he was an off-again, on-again laborer. Well not after the multi-million dollars he got.
  13. by   santhony44
    In very small rural hospitals, there is often not a doc in-house. The one on call has to be within so many minutes of the hospital.
  14. by   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.