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31

AUGUST, 2015

Acute hospital treatments
Lack of risk versus benefit analysis
Intensive Care deaths

Overzealous treatments can lead to a bad death

An elderly male was brought into the Emergency Department by Ambulance after collapsing at home. He was found to have suffered a severe heart attack, resulting in a large amount of damage to the left side of his heart. The left side of the heart is normally powerful, and pumps blood around the body, against the systemic blood pressure.

The acutely ill man was taken to the cardiac catheter lab where a stent was inserted to open up the blocked vessel in his heart.

Due to the severe damage to the left side of his heart, the tissue of the arteries and heart wall were damaged. The cardiologist was in a hurry to overcome the blocked artery.

The tip of the cardiac stent subsequently pierced a heart artery and lodged in the heart wall.

After being unable to extract the stent, the medical team decided to take the patient to theatre to have the stent surgically removed. Open chest surgery was done, and the stent was finally extracted from the heart wall. The left wall of the man’s heart was very fragile due to damage from the heart attack.

The surgical team considered it incapable of standing up to the pressure of pumping blood and decided to sow a patch over the damaged part of the heart muscle to provide support until it could recover.

he man was sent to Intensive Care after surgery. Strict orders were given to keep his blood pressure levels within a narrow range, to keep the pressure on the damaged left side of his heart to a minimum. However soon as arrived in Intensive Care, the man’s blood pressures became unstable. His blood pressure swung high, then low.

Doctors ordered both intravenous fluids and drugs to first raise, then drop his blood pressure. Nothing worked. Doctors then decided to order morphine; reasoning pain might be driving his blood pressure up. A small intravenous line was found, and morphine was injected through it.

Suddenly the man’s blood pressure shot up extremely high, then crashed. His chest drains suddenly filled up with blood. ‘He is bleeding into his chest cavity” yelled a doctor.

Despite aggressive cardiopulmonary resuscitation, the man died.

 

A junior doctor who has used the line to give morphine broke down and cried, saying how sorry she was, that she did not mean to kill anyone, she was just trying to save the patient’s life.

Staff went through the patients hospital notes from both Theatre and Emergency. They discovered that the same peripheral intravenous line used to give the morphine, had been used to give a powerful cardiac drug called adrenaline.

There was discussion that this line may have had some adrenaline in it, which was injected along with the morphine. Speculation began among the doctors that the person who had given morphine via this line had “killed the patient”.

A senior doctor set about ‘analysing’ how much adrenaline the man may have received. Mils of fluid and ratio’s of adrenaline per mil were discussed. The debate went on for half an hour. Finally, the medical and nursing staff all left, to attend to other patients.

The man’s invasive lines, catheters and ventilation tubes were removed, the mess around his bed cleaned up. He lay covered in only a sheet, on an Intensive Care bed for six hours, until the attendants were free to take him to the mortuary on a metal trolley.

The moment his body was taken out, another ward patient was booked to take the Intensive Care Unit bed.

Wikihospitals 2015