Jump to content

Girl Brain Dead after Tonsillectomy

News   (802,709 Views 2,602 Comments)

EaglesWings21 is a ASN, RN and specializes in Medical Surgical.

11,807 Visitors; 380 Posts

advertisement

You are reading page 5 of Girl Brain Dead after Tonsillectomy. If you want to start from the beginning Go to First Page.

wtbcrna is a MSN, DNP, CRNA and specializes in Anesthesia.

1 Follower; 51,814 Visitors; 5,000 Posts

This case is already lost. Here is why if this child had some known co-morbidities that are not being released that were so severe to make this something other than a routine case that was done electively then the ENT and anesthesia were negligent to even agree to the case. Assuming that this was not the case and the only thing wrong with this girl was obesity and OSA then something went wrong with the surgery (res ispa loquitur) the hospital/ENT/anesthesia are ones that have to now prove they were not at fault. The hospital/ENT/anesthesia (whom ever is deemed at fault) should settle and offer this family some closure. It is sad that the hospital seems to not be more forthcoming with information, but that is often the case when attorneys from both sides become involved.

Depending on the facility it is often routine to routinely admit certain OSA patients to the ICU over night for monitoring.

Share this post


Link to post
Share on other sites

4 Articles; 16,180 Visitors; 176 Posts

It is a very sad situation. I also find it amazing that they went straight to surgery first. I wonder if anyone considered putting the child on a weight-loss regime first? As someone mentioned she was not at a healthy weight for her age.

All in all, a very sad situation at a time like this...

Share this post


Link to post
Share on other sites

1 Follower; 1 Article; 37,549 Visitors; 4,383 Posts

This case is already lost. Here is why if this child had some known co-morbidities that are not being released that were so severe to make this something other than a routine case that was done electively then the ENT and anesthesia were negligent to even agree to the case. Assuming that this was not the case and the only thing wrong with this girl was obesity and OSA then something went wrong with the surgery (res ispa loquitur) the hospital/ENT/anesthesia are ones that have to now prove they were not at fault. The hospital/ENT/anesthesia (whom ever is deemed at fault) should settle and offer this family some closure. It is sad that the hospital seems to not be more forthcoming with information, but that is often the case when attorneys from both sides become involved.

Depending on the facility it is often routine to routinely admit certain OSA patients to the ICU over night for monitoring.

This wasn't necessarily elective. Sleep apnea can kill a person if severe enough. Even if elective, things go wrong. Res ipsa loquitur doesn't apply. Left a sponge in place? Cut off the wrong arm? Res ipsa loquitur. Res ipsa loquitur is when the layperson can plainly see the mistake that happened so they won't need an expert to tell the jury what happened. Just dying when someone normally doesn't? Can the person on the street immediately point to the cause? I doubt it because I can see lots of possibilities. For example, DIC. A jury would need that explained. Or whatever they figure out at autopsy. Someone is going to have to explain what happened because it's not obvious.

Until we have more facts, we don't know what happened, even if we can speak a little latin.

It is a very sad situation. I also find it amazing that they went straight to surgery first. I wonder if anyone considered putting the child on a weight-loss regime first? As someone mentioned she was not at a healthy weight for her age.

All in all, a very sad situation at a time like this...

I've seen a kid trached because the family thought that was a better idea than losing weight. T&As on obese kids are very common.

Share this post


Link to post
Share on other sites

wtbcrna is a MSN, DNP, CRNA and specializes in Anesthesia.

1 Follower; 51,814 Visitors; 5,000 Posts

This wasn't necessarily elective. Sleep apnea can kill a person if severe enough. Even if elective, things go wrong. Res ipsa loquitur doesn't apply. Left a sponge in place? Cut off the wrong arm? Res ipsa loquitur. Res ipsa loquitur is when the layperson can plainly see the mistake that happened so they won't need an expert to tell the jury what happened. Just dying when someone normally doesn't? Can the person on the street immediately point to the cause? I doubt it because I can see lots of possibilities. For example, DIC. A jury would need that explained. Or whatever they figure out at autopsy. Someone is going to have to explain what happened because it's not obvious.

Until we have more facts, we don't know what happened, even if we can speak a little latin.

I've seen a kid trached because the family thought that was a better idea than losing weight. T&As on obese kids are very common.

It was scheduled so basically it is considered elective and rarely( and I haven't done one yet or heard of one) would tonsillectomy be an emergent procedure.

This is a done case unless the hospital can prove without doubt this was caused by some unknown comorbiditie. When and/if this goes to trial the hospital is likely to lose several million dollars more than if they would have settled out of court, because what an untrained jury will see and be told is that a) they should have refused the case because the child was not a good surgical candidate or b) the staff and/or surgeon did not respond appropriately to an emergency. The jury is just as likely to side with parents just out of sympathy.

A throat pack left in would not have caused this kind of bleeding and the child wouldn't have been able to talk. Most of the time a throat pack isn't needed in this age because we use cuffed tubes.

There is also nothing in literature they would suggest not taking the patient back to try to ligate any bleeders.

Unidentified coagulation disorders in post-tonsillectomy hemorrhage. - Free Online Library

Tonsillectomy in Children

Share this post


Link to post
Share on other sites

BlueDevil,DNP has 25 years experience as a DNP, RN and specializes in FNP, ONP.

24,450 Visitors; 1,158 Posts

If she was in DIC the only thing to do is replace the volume (which is sounds as if they were doing) and administer heparin. Taking her back to the OR would just hasten death. So I understand why they didn't take her back to the OR if she was in DIC, there would be no point. It's impossible to say anything for certain, but this case sure sounds like DIC to me. There isn't anyone to blame for that.

Share this post


Link to post
Share on other sites

wtbcrna is a MSN, DNP, CRNA and specializes in Anesthesia.

1 Follower; 51,814 Visitors; 5,000 Posts

If she was in DIC the only thing to do is replace the volume (which is sounds as if they were doing) and administer heparin. Taking her back to the OR would just hasten death. So I understand why they didn't take her back to the OR if she was in DIC, there would be no point. It's impossible to say anything for certain, but this case sure sounds like DIC to me. There isn't anyone to blame for that.

The number one recommendation for a hemorrhage after a tonsillectomy is to bring the patient back to the OR. The OR is the best place to manage the airway and to ligate the hemorrhage from tonsillar hemorrhage. A delay in bringing the patient back to the OR can have life-threatining consequences. As the one study reported it is often hard to tell how much bleeding a child is having after a tonsillectomy, because children will often swallow the blood.

It would be extremely rare for DIC to occur after tonsillectomy. I couldn't even find a report of DIC after tonsillectomy to get some kind of accurate incidence of DIC after tonsillectomy.

Heparin is no longer routinely recommended for DIC except in very specific incidences. Medscape: Medscape Access

With published recommendations on how to treat post-tonsillar hemorrhage I still do not see how this is not a case of negligence, but with only knowing what the news media is reporting this information is biased at best.

Share this post


Link to post
Share on other sites

sapphire18 specializes in ICU.

1 Follower; 15,571 Visitors; 1,082 Posts

This is such a tragic story and breaks my heart to hear of this, but shouldn't the people caring for this girl realized that she was hemorrhaging and that amount of blood was NOT normal? I mean I am not even a nurse yet but I realize that hemorrhaging after surgery is a HUGE risk and nurses need to assess and act quickly if it happens.

What are your opinions on this situation and what you would have done different had you been caring for this girl?

The people caring for this girl DID realize that she was hemorrhaging, they DID assess, and I can only imagine that they DID act quickly. The girl was in ICU. She was receiving blood transfusions. Short of going back to the OR (which is clearly not nursing's decision), there is nothing else to be done!

My opinion? This is a tragic story, especially at this time of year. I am not sure why the girl's parents would not have tried to have her lose weight; obesity is such a high risk to surgical and post-surgical complications. Maybe they did. The fact is- this girl is dead, and it is wrong to keep her body on machines in the ICU- there are many, many reasons why this is wrong.

My heart goes out to her family and to all the staff involved in her care...I cannot imagine the distress this case is causing to everyone connected to it.

Share this post


Link to post
Share on other sites

Caffeine_IV has 7 years experience and specializes in LTC, med/surg, hospice.

16,609 Visitors; 1,198 Posts

Very sad case. The family is obviously distraught but unrealistic. If the outside expert agrees with brain death...then what?

I hate to read the laymen comments thinking that the hospital wants to remove support because of money, insurance or to hide something. Accusing the hospital of murder. And tons of people confusing being in a coma with brain death.

The reports say the grandmother is a surgical nurse?

Share this post


Link to post
Share on other sites

12,200 Visitors; 983 Posts

I once spoke to a medical malpractice lawyer who told me it's very hard to win cases like this because you need to prove that the hospital deviated from it's standard of practice. With no cameras and good charting, how can anyone prove they did something that deviated from their policy and procedures?

I'm sure the parents had to sign a consent saying that they know death is a risk of anesthesia and surgery.

Share this post


Link to post
Share on other sites

1 Follower; 32,314 Visitors; 6,978 Posts

if the tonsils were the problem losing wt wouldn't be the cure. and sleep apnea is sometimes a contributing factor to obesity. so around and around we go.

It is a very sad situation. I also find it amazing that they went straight to surgery first. I wonder if anyone considered putting the child on a weight-loss regime first? As someone mentioned she was not at a healthy weight for her age.

All in all, a very sad situation at a time like this...

Share this post


Link to post
Share on other sites

caroladybelle is a BSN, RN and specializes in Oncology/Haemetology/HIV.

29,411 Visitors; 5,486 Posts

It was scheduled so basically it is considered elective and rarely( and I haven't done one yet or heard of one) would tonsillectomy be an emergent procedure.

While I generally don 't think of a tonsillectomy as an emergent thing, I have seen 3 cases ( 2 were adults) where tonsillitis rapidly developed to the extent that the pts had trachs and vented, due to airway obstruction. All three pts were significantly obese and had OSA. Thus, I would suspect that if the pt had frequent tonsil / throat infections, that a tonsillectomy would more of a necessary procedure than an elective procedure.

Share this post


Link to post
Share on other sites

imintrouble has 16 years experience as a BSN, RN and specializes in LTC Rehab Med/Surg.

51,041 Visitors; 2,397 Posts

I know this isn't a weight loss thread, but making a 13 yr old do ANYTHING they don't want to do is next to impossible.

I have a daughter who has been obese for most of her life. I tried everything to help her lose weight when she was a teenager, short of locking up every piece of edible material. I even considered locking the cabinets and the fridge. Even if I did that, there's food at school, at neighbors houses, family members, and friends.

Then factor in trying to make them be more active. You can't MAKE another person exercise. I even tried to do that.

Obese>airway obstruction>sleep apnea>daytime lethargy>no exercise>obesity

It truly is a cycle.

Share this post


Link to post
Share on other sites
  • Recently Browsing 0 members

    No registered users viewing this page.

×