Interesting Read

mwbeah · May 21, 2005

Let me start by saying that I have never been stationed at Tripler. I have also had two babies with the military medical system (one premie requiring a four week PICU stay) and have had excellent care. I have also been a civilian labor and delivery nurse at what US New and World Report reported as having the 6th best OB/GYN department in the country for four years from 1996-2000.

These incidents do not only happen at government facilities, I can assure you. A similar incident happened at my previous place of employment (I can say it is a very prestigious hospital in NYC). In the inicident I have first hand knowledge of, the mother and baby died because of what was determine to be a total spinal resulting in respiratory arrest and ultimately cardiac arrest.

I believe the reason you don't hear about those events is two-fold, the high priced legal teams associated with large civilian hospitals and the fact that a story about a government failure makes good press.

I am very saddened that the event happened, but that is an associated risks we have on our consent forms.

We are easy to judge others without the full story (I know I don't have it). You only hope it doesn't happen to you. People early in their practice think it will never happen to them, I hope it doesn't. But, I wouldn't "monday morning quarterback" the situation either. What this situation tells me is that my continual drill of contigency planning I do in the event it happens is worth the effort.

Mike

SmilingBluEyes · May 21, 2005

Stupid question here:

but are not "test doses" done to diagnose inadvertent intravascular injections BEFORE locals are injected---thus preventing such calamities like this?

I do not pretend to know much about anesthesia, but I had to ask this!

mwbeah · May 21, 2005

Stupid question here:
but are not "test doses" done to diagnose inadvertent intravascular injections BEFORE locals are injected---thus preventing such calamities like this?
I do not pretend to know much about anesthesia, but I had to ask this!

I would hope so......my statement was made to remind people that something out of the ordinary can happen anywhere anytime. If you haven't had a situation occur then you probably are fairly new in your practice. Risks are stated because they happen, just pray its not on your watch (otherwise you can see that people criticize rather that learn from the experience). Interventions have risks, what we do is not benign. What sets the good and bad apart (BOTH civilian and military) is how we react to the adversity.

Hope we learn from this and improve our personal practice habits.

Mike

SmilingBluEyes · May 21, 2005

Let me clarify something: I am not a CRNA nor MDA. I am a labor/delivery nurse with 8 years' experience in that area---- and no, I have not seen such a situation come up. The test doses pick up the misplacement virtually every time, from what I can tell. The one thing I have seen many times is the occasion of profound and precipitious drops in blood pressure and predictible fetal reactions.......fortunately, this all can be anticipated and treated.

I said I did not pretend to know anything about anesthesia, remember?

I just asked the question. I am not a CRNA, and don't pretend to know all the ins and outs of labor anesthesia---- just trying to learn something here.

mwbeah · May 22, 2005

Let me clarify something: I am not a CRNA nor MDA. I am a labor/delivery nurse with 8 years' experience in that area---- and no, I have not seen such a situation come up. The test doses pick up the misplacement virtually every time, from what I can tell. The one thing I have seen many times is the occasion of profound and precipitious drops in blood pressure and predictible fetal reactions.......fortunately, this all can be anticipated and treated.
I said I did not pretend to know anything about anesthesia, remember?
I just asked the question. I am not a CRNA, and don't pretend to know all the ins and outs of labor anesthesia---- just trying to learn something here.

Not trying to preach, but when you used ALL CAPS with your previous posting it appeared as if you were judging. Like I said, just hope it doesn't happen on your watch because it will happen somewhere, sometime.

Mike

Mulan · May 22, 2005

Not trying to preach, but when you used ALL CAPS with your previous posting it appeared as if you were judging. Like I said, just hope it doesn't happen on your watch because it will happen somewhere, sometime.
Mike

Just reading here, but where do you see ALL CAPS?

Audreyfay · May 22, 2005

. . . intravascular injections BEFORE locals are injected---thus preventing . . .

I had to look twice to see it. We're all human and make mistakes. Such a tragic story. :crying2:

cannoli · May 22, 2005

I had to look twice to see it. We're all human and make mistakes. Such a tragic story.

That's just one word, and I'm sure the caps were used for emphasis, I don't see anything negative about it.

TLC-JAX CRNA · May 22, 2005

Could have been IV injection or high spinal. Either way, pregnant women desaturate very quickly(little to no FRC and reserve)- intubation is precarious even in a controlled environment- i.e. OR suite and planned/urgent situation. I agree with a previous writer... Would need more details from "both" sides to really appreciate what happened... I practice in the civilian world, but we have military SRNAs training at our facility- they are very well trained and usually have a strong academic foundation regarding anesthesia . I suspect things got really messy quickly, although intubation equipment is usually stocked on the epidural cart- intubation may have been difficult- and mask ventilation ineffective - leading to respiratory and cardiac arrest. The fact that she did not die at the time of the event suggests that there was some measure of success in the resusitation efforts- I have participated in resusitations lasting longer than 8 minutes with little to no residual effects (however, these were not pregnant women). In any event, I'm sure that nobody feels good about this outcome. Medicine is not a perfect science, that's why we discuss risks when we consent patients. I think negligence and gross errors should be investigated and corrected-- though I do not believe that law suits involving "huge" settlements is the answer - a standard of care should be expected- medicine cannot always predict to whom and when unfortunate incidents will occur. I agree the flight situation seems a bit much, again we lack the details of her health at the time - some rehabilitation centers will take vent dependent or extremly debiliated patients- however patients must be stable before transport.... guess for me, too many blanks to draw any real conclusions about what happened and why...

SmilingBluEyes · May 24, 2005

I did not print in all caps, just one word for emphasis. It was not a judgement or condemnation at all.

And, I realize thoughts often don't come across (emotionally, anyhow) online as we may intend. But I was not judging anyone, just emphasizing what I am trying to understand here. I never said I judged anyone in any place in my post. I agree with some other wise posters; there must be more to the story. There almost always is.

Perhaps, posting "headliners" like this creates some very strong emotional reactions and yes, even judgements may be made by many people. Really No one with critical thought is truly non-judgemental, especially the family who lost that patient, right?

Like I said, I am trying to understand, simply. Don't read more into it than that, ok?

SmilingBluEyes · May 24, 2005

Could have been IV injection or high spinal. Either way, pregnant women desaturate very quickly(little to no FRC and reserve)- intubation is precarious even in a controlled environment- i.e. OR suite and planned/urgent situation. I agree with a previous writer... Would need more details from "both" sides to really appreciate what happened... I practice in the civilian world, but we have military SRNAs training at our facility- they are very well trained and usually have a strong academic foundation regarding anesthesia . I suspect things got really messy quickly, although intubation equipment is usually stocked on the epidural cart- intubation may have been difficult- and mask ventilation ineffective - leading to respiratory and cardiac arrest. The fact that she did not die at the time of the event suggests that there was some measure of success in the resusitation efforts- I have participated in resusitations lasting longer than 8 minutes with little to no residual effects (however, these were not pregnant women). In any event, I'm sure that nobody feels good about this outcome. Medicine is not a perfect science, that's why we discuss risks when we consent patients. I think negligence and gross errors should be investigated and corrected-- though I do not believe that law suits involving "huge" settlements is the answer - a standard of care should be expected- medicine cannot always predict to whom and when unfortunate incidents will occur. I agree the flight situation seems a bit much, again we lack the details of her health at the time - some rehabilitation centers will take vent dependent or extremly debiliated patients- however patients must be stable before transport.... guess for me, too many blanks to draw any real conclusions about what happened and why...

I appreciate this post. Thank you; it helps me understand more and I agree "big settlements" and lawsuits are not necessarily the answer to such situations. Really, we all need to learn from these things and take them under advisement. Thank you for this post, again.

medic1488 · May 28, 2005

Just curious from the outside, is it common place to have a neonate and adult code cart in the room (or right outside the door) at deliveries?