Posted on 11/21/2008 4:27:58 PM PST by Michael.SF.
Most doctors don't know about Dysreflexia I found out. It's more common to quads and paraplegics but can hit anyone if the bowels or urinary tract is blocked. You don't have much time to second guess either.
My wife is incomplete quad and is highly prone to bladder stone and UTI's so much so she's on permanent antibiotics and has been for many years. She was having some problems that we suspected was UTI so I called the on call urologist. He called in a prescription which was the norm for her. By the time I could drive 40 miles round trip to the drug store and got home she was in trouble. Breathing labored and BP was out of whack. I took her in to the ER and the doctor immediately paged her urologist and Primary Care doc. At first when I took her in I didn't think things were real that bad maybe a day or two on IV. When I saw the look on our primary docs face it was a concern I hadn't seen before and I knew it was real bad.
He came out and said she had pneumonia and CHF. We're gonna see what we can do. They had her on suction and several IV's real fast and started getting the fluid out of her lungs. About a week later she was fine. CHF is always serious but that type is the one few that can be cured. They attributed it to a stone she couldn't pass.
She had been Foley dependent for about 18 years and they finally did a double GI & Urostomy bypass to try and reduce the infections. The bad part was they couldn't get the bladder out. It was too hard to reach and vascular due to anatomy issues and risk outweighed the benefit. That's just one of the type things they usually discover only in surgery and she had two of the finest working on her. The by-passes were a major quality of life improvement though and I think had they not done it she would not be here now.
The part that bothers me in the article though if it's right is that woman had a stone history. That's nothing to mess around with or second guess.
Experiences can teach some very weird things sometimes LOL. I about missed Dysreflexia in myself thinking bladder blockage was part of something else wrong with me that they had yet to diagnose. Long story but I was having some neuro issues. Last thing I needed was an SSRI. Protocol for G.A.D. called for it though. Benzo's they said were too dangerous. When G.A.D. is from sensory processing damage origins SSRI's are not your friend but Xanax is when properly prescribed. :>}
No s..., Little Beaver! I would at least like to know the name of the test they mean.
Almost 30 years since I had my first (and hopefully last!) kidney stone; and I've helped care for many poatients hospitalized with one, and even severe renal disease, but never came across this.
When I was in labor with my son, over 19 years ago, my doctors were on the phone with their attorneys instead of treating me (because they had botched treating me so badly they were convinced I would sue once my son died... he didn’t, I didn’t).
One has to be somewhat stupid to be able to put up with all the lefty loonies in the industry. If you have a rational thought you'll be laughed out of there in an instant.
I'd be really hacked off alright. It wouldn't make me a victim necessarily.
They had less chance of picking that up if they didnt give her a blood test, as the article indicates.
I'm afraid you might be missing the whole picture. If someone presents to the emergency room with severe flank pain, radiating down their leg or into their groin with a history of pain so severe it makes you vomit, well you need to get either a non-contrasted CT scan or if not available an old fashioned IVP. (you would need a blood test to see kidney function because of the dye used in an IVP)
Now if you have a patient with no fever, no history of chills, isn't immunocompromised, after pain relief has no tachycardia (fast heart beat), abnormal lowering of blood pressure or a return of pain.... then you can dishcarge them depending on the size of the stone and where it's located in the ureter (tube from kidney to bladder). Give them some pain meds, urine strainer, urology follow up and instructions to return for temp more than 100.1 or pain that isn't relieved with meds.
However I need to add something... a doctor doesn't have to get the correct diagnosis but has to do what is the "standard of care" and what a physician with his expertise would do in that situation in order to diagnosis and treat the patient and symptom presentation.
Now do we get blood on every person that walks into the ER to make sure they don't have an infection? Nope. Cause sometimes you don't need a blood test. Sometime even if a blood test shows normal amount of a cell type that is looked for... ya still got an infection. What's funny is that even if you have NO BLOOD in your urine you could have a kidney stone.... and even if you had the same presentation of flank pain and blood in the urine you could have an Aortic Aneurysm.(very bad).
As far as giving them 50 million or 75 million dollars.... sure why not. Now if a doctor orders a blood test on everybody that walks into his office or ER will anybody complain about the cost? Nah... no complaints since it's free, right? So a doctor that tries to use clinical guidelines may not get a blood test to save the patient money and not look like a guy on the take with a piece of profit out of the lab.... He/she might not give antibiotics in order prevent the overuse of meds, but maybe misses a bacterial infection. So he's damned if he does over test and over medicate.... and he's damned if he doesn't .
Before I get slammed/flamed or called an apologist for the miscreants in medicine that practice "double-O" doctors (licensed to kill)... I don't. I think that malpractice attorney's actually provide a service by scaring the cr#p out of any doctor that thinks he can slide on updating his education and skills.
Do they sue the wrong docs... yep sometimes , a lot of the time it's just a fishing expedition with easy money to be made "settling or arbitrating" a case. The real bad cases usually get settled unless someone starts throwing around numbers like 55 or 70 million dollars.
Sounds like she got septic, threw some septic emboli or lost her blood pressure and sloughed off the tissue farthest from her heart... feet, hands, tips of ear, nose etc....
Now about the "mistake" part. If there are any medical freepers scanning this you will see how frustrating this can all be. A friend of mine was in a small ER 40 miles from a trauma center when a trauma code came in. Blunt trauma chest, extraction then cardiac arrest. .... well they scooped him and worked him till they slammed through his doors. He correctly assumes either torn aorta or tamponade... cracked his chest and finds a small rent in the aorta with tamponade.
Guy gets transported to the trauma center 30 minutes after hitting his door, with a full ER. Guy lives, has limp and residual left sided weakness of a leg, but other wise all other systems are a go.
My buddy went through 4 years of depositions, chart review, expert witness testimony and finally right before the trial his malpractice company settle for under 120K. They did the math and figured even if they won it would cost them more. If my friend wanted to fight he would have to pay all the fees if he lost and nothing if he settled. Why the suit... failure to transport and treat in a timely fashion. They found some experts that tracked every minute from the time he hit the door till the calls were made and he was in the ambulance and into the other hospitals OR. They calculated the amount of money he sought, divided up by the time from ER to OR and figured that my buddy was liable for 30 percent of the time. So he owed 30 percent of the suit. Kewl, huh?
He was told by his attorney and another consultant that if he'd of let him die, no suit. Cause blunt chest trauma arrests are universally fatal... almost. But a guy with a limp... is a guy with a limp. He's doing occupational medicine now and has weekends off and no night shifts.... unfortunately for Florida he is now a South Carolina doctor. Unfortunately for South Carolina, he isn't an emergency room doctor anymore.
If the doctors in the hospital hadn't aggressively resuscitated the patient, she'd of died... but instead the intensive care doctors have a live patient without hands or feet. I don't know the particulars of this case but I'm thinking it's going to be sad all around. ..... except for the attorney, of course.
“I’m afraid you might be missing the whole picture.”
I described the picture that the plaintiff lawyer will give to the jury as stated in the article. I posted that in response to the question of whether an infection could have been associated with her condition. The answer is yes.
Let me explain something to you. Most jurors, particularly jurors in Brooklyn, have the attention span of first time voters who watch MSNBC. They grab on to a soundbyte and run with it.
They’d rather side with “hope and change” than explanations of why someone was wrong on the surge in iraq, or why someone wanted to submit the Russia-Georgia dispute to the UN.
These are people who accept Pelosi’s explanation that the Rs were responsible for the Fanny and Freddie meltdown, and who think Sarah Palin really said she can see Russia from her house.
Most of them dont have the brainpower to absorb detailed medical explanations that may exculpate a hospital, particularly when the plaintiff is a young woman sitting there with no hands or feet.
So when the original poster asked if there could be an infection associated with her condition, i read the article and answered it the way it would be approached in court- YES, and a blood test could have revealed that.
If the defense lawyer then wants to stand up and start explaining how long it would take to figure out the results of the culture, whether it was proper to not admit her to the hospital, whether she would have lost her extremities by then no matter what they did—good luck with that.
KISS= Keep It Simple
More likely than not, the routine would be a CBC - which is a test which is very standard as it is a complete blood count. If her white cell count was not elevated they would not suspect an infection. Generally speaking, they don’t culture you if they don’t suspect an infection as the results take a couple days to see what grows. They let her go home. The article does not tell us all of the details of what happened. Other signs of infection are elevated temperature, tachycardia, low blood pressure (sepsis - but this is a lagging indictator)
I ended up with kidney stones while I was pregnant with my third son. I didn’t know—thought the back pain was just b/c it was my third and the other two had me worn out. After delivery, I developed an infection and ended up back in the hospital. I had sepsis (sp?), which is when an infection spreads to your blood. It can be deadly.
I’m no expert, but I was running a very high fever. If she was running a fever, I think a blood test would be a no-brainer.
Sounds like a terrible situation. Too much unknown info to pass judgment—why didn’t she go to her doc? Was she feverish? Did they treat her in any way the first time she went?
I already replied to someone else, but I had a kidney stone related infection—blood tests do pick it up. In my case anyhow. If untreated for too long, the infection spreads to the blood—sepsis (sp?). It’s very dangerous and can be deadly.
See George C. Scott in the movie “The Hospital.”
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
I saw it when it first hit the theater, for a long time I cringed every time I thought of having to go to the hospital.
unlikely for MRSA to involve 4 limbs to that extent. sounds more like she had septicemia and required medications for blood pressure support called pressors
Pressors at high strength and prolonged ues will often lead to gangrene of the hands/feet due to poor blood flow. But without seeing the record that is just a guess.
The other one was an attending ER doctor that when my wife came in the ER with what could be considered a psychotic state he refused treatment even so much as blood work. Just vitals ands they were way off. He kept on refusing while waiting on the state and she finally went unconscious in an exam room that I found her in completely unresponsive. Her vitals BP pulse etc were very elevated as well. I gave complete history including medications etc. She had a Cardiac History and I suspected either stroke or aneurysm. She had already had a spinal infarction.
When I found her in the exam room I yelled for help and a nurse came in saying we'll do something. Next in walks the doctor. I said she's unresponsive this is not normal she won't wake up. He just stood there and was fixing to walk off. I was getting pretty angry at this point and yelled help her you Stupid Idiot no mental illness does this he still refused. So I took her out of the hospital for a level one hospital.
They were highly interested till I was just a bit too honest and told them what had happened. They used amonia and got her back around and they too changed their tune to transfer. I asked them for some diagnostics to be done first and especially our primary care doctor be notified. About four days and nights of hell later we got the answer. Thanks to some discussions I had in FR I remembered some threads on SSRI's and some swearing they were very dangerous.
To shorten this up at about the fourth day I came home and went on line to a search engine. Trazodone +Zoloft +Adverse reactions. I had hits. Better yet I had THE hit. I'm not a doctor but reading an article I saw what was going on. I went back to the hospital. I talked to the floor supervisor and said I need to talk to her doctor it's urgent I think I know what's wrong and she needs the treatment now or she can stroke. She said he comes in tomorrow you can see him then. I said OK you will not give her any medications except Ativan unless you have my permission. Next morning house doctor was mad. I took him out in the hall and said I think she has Serotonin Syndrome. He said that's just pure rubbish. I said read it then doctor and then tell me who wrote this. It was his hospitals pharmacology professor. He said well Ok now when can I transfer her. I let him have it and said you better never say that word after what's happened someone goofed big time.
Next morning {fifth day} someone must have been scared or doing CYA. The MRI and CT SCAN I had asked be done the first day got done. A fresh bleeder was there. Thankfully small.
The thing that convinced me though was for the first two days she was non stop awake and violently thrashing. Her skin was blotchy and her BP & pulse elevated her breathing was on O2 when she'd keep it in. Then real early the third morning she was returning to normal quite aware of her surroundings etc. Then in walks in a shrink who spent 5 minutes with her and said well let's up the Zoloft. Next day at noon the nurse gave it to her.. In about one hours time all symptoms returned and stayed with her two more days. They still didn't catch on. At day six she was discharged partly Amnesic.
Had the first doctor bothered to do a PDR he could have gotten the same information I did. He was too interested in doing a patient dump. Her history warranted more than what she got. He wasn't interested in it either. I didn't sue him. But Chief of Staff got a letter though and he had treated her before for a pressure sore in the ER. I said if I ever hear of another person being done this way by the ER attending we will contact them as a witness.
That likely carried far more weight in getting the issue addressed than a lawsuit. It proved we weren't out for money but wanted an injustice addressed and corrected. In 23 years of doctors those two were the only ones I felt needed to go find another line of work.
BTW the first hospital I took her too even had a Pysch unit. He didn't even bother to call them nor her primary care doctor even after I requested he do so because she could have told him it was not true psychosis. Beyond some expected depression and anxiety she had no serious mental history.
The only reason she had not gone over the edge sooner was because she was on a small dosage of Xanax which is a Benzo and the class of drug used as an antidote for Serotonin Syndrome. Ironically she was on the SSRI's for PTSD because of the dentist. She was needing a full mouth extraction and was literally scared to death. From this though came the good news.
The Oral Surgeon who agreed to do it insisted on a treadmill test first. This was done a couple of days before the Serotonin episode. Turns out the treadmill revealed no heart issues beyond what the SSRI's were creating. For nearly 18 years she took BP meds she didn't even need. She had been on the SSRI's maybe three months. Things can get weird. We got the Cardiologist report after she got out of the hospital. He said he saw a slight abnormality. We explained what had happened and he said that explains that then.
Like I said some doctors are GOLD and some need other jobs as they know not what they do and don't care. All are human and I realize that also.
I've had doctors give patients meds that absolutely refused to consider a cause of bizarre symptoms till I show it to them. Even eye drops can have systemic affects.... it's a real "eye opener" (pun) when you show them that eye drops can affect heart rate and blood pressure.
Demerol is one of the worst. Especially with some of the Parkinson meds.
I've unfortunately worked on a kid that was killed by a dentist doing IV sedation without a pulse oximeter or cardiac monitor.... really STUPID. So he finished the case and since all he sees is the mouth and it's not moving, he thought all was well. It wasn't.
I think the best advice is to be present or have someone else present that cares. If you ask a question and it's not answered then you need to try to leave if you can. The problem with ER's is that it's not an "office" and you have little choice when you go there.
Most of the board certified docs I know are thorough but all it takes is one lazy, sleepy, impaired, psychotic miscreant doctor to give them all a bad name.
When I had a tendon transfer done after a major accident to my right arm, I ensured that the hair clipping was done on the proper arm, then put a sticky note on it saying “Cut HERE!” He did the correct one!
Your explanation is excellent, but really...don’t bother. Those that aren’t ignorant to medical matters already understand, and those that think that every bad outcome in medicine is due to malpractice won’t even read what you had to say.
You cannot foresee sepsis, and people with diabetes are susceptible...end of story. SHe could have had no fever, no chills, normal WBC, minimal stone with no obstruction and had sepsis develop within 24 hours.
This is why I hate medicine, and why I try daily to talk my daughter out of persuing a career in the field like her Dad.
Oh No!
My Beloved husband is on Paxil, maximum dosage, for Parkinson’s depression, and has a history of kidney stones, and from “aldosteronism” undiagnosed, but now treated with Spirinolactone.
Is this something else I have to worry about? I am so depressed, because I am his only care-giver. There are days when I feel overwhelmed.
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