I once ran a call to a local church for "diabetic problem." When we arrived, we were met by a pleasant woman who stated that she was in the area on vacation, and her husband forgot to pack his diabetic medication. They had been kneeling in prayer when her husband stated that he felt like he was going to pass out, and wanted to sit down. I asked my EMT to get a blood sugar and some vitals, and started getting information from the wife for the report. The patient looked a little tired, his color was off a bit, and he was sweating, but being a tourist from the north during the month of July in Florida will do that to you. As I was filling out the report, my EMT yelled over that the blood sugar was 166, BP 92/54, and his heart rate was 42.
Oh crap.
The monitor revealed a third degree AV block. I placed the pads on him and began pacing immediately. We tried to get an IV for some medication access, but his veins were flat. I was finally able to get an 18 in his right EJ, and we began giving fluids. He complained that the pacing was painful, and so I gave him 2mg of valium to take the edge off. His BP was now 100/62, and I thought we had done OK.
Then he went into respiratory arrest.
I tubed him, and his EtCO2 looked good, and over the next few minutes, his O2 sats went from the 70's into the upper 90s. His lungs sounded wet, but the clinical signs were there. CHF, maybe? We delivered him to the ED with vitals of: HR 80(paced), Resp 12(BVM via ETT), BP 110/70, SaO2 96, EtCO2 42.
The ER doc listened to the lungs, and consulted with the RT. They decided to extubate. I pointed them to the EtCO2, and the Doc said "That stuff isn't accurate. You are in the stomach." He then ordered the nurse to discontinue the pacing, and give 0.5mg epinephrine and 0.5mg atropine. I showed him the original strip and pointed out the original rhythm.
I went out to see the wife, and told her we were leaving. I wished her luck. As I was leaving, the doctor came out and informed her that her husband had passed away. He then told her, right in my presence, that if the paramedic had not placed the tube incorrectly, her husband may have lived. I felt about three inches tall.
A complaint was filed against me with the state department of health, both by the doctor and by the patient's family. The investigation eventually found my treatment to be correct.
That was over 5 years ago. I still have copies of the report, the strips, and the findings of the state locked away in my safe.(redacted, of course) Even today, I can look at the waveform and see that my tube was correct. Through all of that, I still sometimes wonder what would have happened if I had made a different decision that day. Maybe I should not have given the valium (did that cause the resp arrest?) Paced earlier? Gone to a different hospital?
I still see that doctor from time to time, wandering through the hospital. Funny thing is, he doesn't even recognize me or remember who I am.
4 comments:
I commented on this in a long post at The Blame Game. I like the title.
My sympathies. I once had a doc take out a nasal tube to very much the same result. I crawled up into his stuff while he was doing it and the patient died in front of us all. Instead of the doctor trying to rat me out I let the doctor have it. Not my most professional moment. He made liek a coward and ran. I went to the family and discussed what happened. The doc was afraid of me, not the other way around. I was lucky. remember this though:
YOU DID NOTHING WRONG. Say this three times and go egg the doctor's car. You will feel better.
You haven't filed a compaint against HIM? Taken him out back and kicked his ass.
That man is dangerous. His actions are inexcusible. Sounds like your documentation (especially of the EtCO2) is spot on, appropriate, and is exactly the reason we document.
Bummer of a call. I hate it when MD's use medics as their scapegoats. Maybe if the doc hadn't extubated or DC'd pacing the guy would have lived.
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