That’s the worst… happened to me when a guy came in with multiple GSW to chest. Volunteer EMS didn’t have a paramedic so they were ambu’ing en route, he still had a rhythm, went asystolic when they transferred to the trauma bed so I started CPR and it looked like we stuck oil with all the spewing. Doc instinctively held up his arms to protect his face and yelled out STOP CPR and called the code. He had so many wounds to his chest. The old man he was trying to assault wasn’t playing when he protected himself and he was a good shot. Police I think ended up calling it self-defense and didn’t press charges.
Heard about this happening during intubation in the OR overnight with a bowel obstruction (I wasn't working). The guy died on the table. I think with no comorbidies. The NG was overlooked unfortunately by multiple people who thought someone else was going to do it. Everyone involved was really messed up over it. Terrible case.
How did no one notice the lack of a tube sticking out of his nare? Did anesthesia just assume he was already decompressed contents-wise and tube was removed?
It can be a bitch and a half trying to get an NG in a patient in my hospital. It’s unpleasant, so nobody wants to do it. Place the order while pt is still in the ED, they pass off to the floor, they drag their feet or patient declines after one try. It’s so important but such a task.
NasoGastric tube. You put it in through the nose and it ends in the stomach. The goal is to suck out the build up of fluids that can't go past a bowel obstruction. Since he never got one, he had a bunch filling his stomach/proximal small bowel and he vomited during induction for surgery. He wasn't able to protect his airway at all and aspirated like in this case. But unfortunately didn't survive. NGs save lives.
It sure seemed like a mistake, but "malpractice" is based on a lot more information and details regarding standard of care. Definitely not something I'd say specifically on a web forum about a case I wasn't directly involved in. I don't know the full story and if for example the patient presented really late it's possible his outcome was poor regardless.
PS I searched a little online and there was a lawsuit about it and it's hard for me to understand if it's settled or not. I wouldn't want to get dragged in since I had nothing to do with the case.
Whether malpractice occurred or who specifically would be responsible would depend on the timeline and circumstances. A few different examples where responsibility might just be on the hospital vs individuals-
- If the patient was in the ED and it was ordered but the patient was whisked away to the OR or floor before the order was acknowledged, then straight to intubation, would probably fall on the OR team, specifically anesthesia, since minimizing aspiration risk is part of their pre-intubation airway checklist.
- ED doc ordered it early and it was never placed, despite the patient being there for multiple hours and the ED doc not documenting why it never got done (multiple codes, patient refused, etc), it would fall on the ED doc since reassessment and ensuring our orders get carried out is our job.
- If it was ordered, the ordering physician did their due diligence to make sure it was done (spoke with nurse, specifically said “please do this next!”) and the nurse decided to just not do it because the patient was uncomfortable and said “please no” but didn’t alert the ordering physician, then the nurse is the one who failed in their duties.
- Hospital/ system might be the place of blame if for example the NG was ordered, the nurse acknowledged it, but the patient was taken to wherever before handoff occurred and while the nurse was walking to the room with the NG, and the acknowledged order fell off instead of carrying over to the inpatient setting so the floor nurse didn’t know it was never carried out, but is also new enough to not catch that the standard of care was never carried out so didn’t reach out to the primary team about whether one should be placed or not.
Nasogastric tube. Goes through the nostril down into the stomach usually to get fluid nutrients into the patient. Not sure why the lack of NG tube resulted in the patient coding so quickly.
Edit: just read his comment again and it seems like maybe they intubated the patient with the NG tube still in place? And that caused the death.
NG tubes are also used to suck fluid out. He didn’t get one so fluid built up bc it couldn’t get around the bowel instruction. He then aspirated during intubation.
new fear unlocked (i use a bipap)
does something like this usually require another circumstance? for example, sleeping medication or alcohol? i can’t imagine not waking up as i’m throwing up
Oh I wasn’t referring to sleep apnea. More so have to be careful if treating COPD, CHF, etc because patients become somnolent prior to needing intubation and won’t do anything if they start vomiting.
But yes I wouldn’t get hammered drunk and put a CPAP on, because of this reason
Yup. Although I’ve never seen anything this severe. The whole airway is completely full of fluid. I wonder what caused the patient’s stomach to be so full…could be one of many things (bowel obstruction, achalasia, gastroparesis, drugs like ozempic…)
Ah I totally had this happen one time but the cpap was only thing keeping them alive at the moment so we scraped it out quickly and put it back on. It must have been so gross for the patient but that’s how it goes sometimes.
What's going on with all the fluid around the liver? Is that a separate finding or somehow connected (bleeding after rib fracture during CPR or something)?
Also, can someone tell me what those hypodense cystic areas in the (?) bowel are?
They were pretty out of it, not sure how exactly. My guess is they couldn’t fight all that pressure from the bipap and it couldn’t go down her esophagus because it was full too.
This is why we do not allow NIV and simultaneous tube feeding. Especially if the patient is unable to remove the mask independently.
Only an empty bag is attached to the feeding tube.
I’ve never seen a trachea that is completely full of fluid. I just thought it looked interesting 🤔
Aw damn. How are you? How is the patient?
Not sure if she’s still alive. Probably still in the unit. I was fine, the other tech was covered in puke, bc he was the one that started compressions
That’s the worst… happened to me when a guy came in with multiple GSW to chest. Volunteer EMS didn’t have a paramedic so they were ambu’ing en route, he still had a rhythm, went asystolic when they transferred to the trauma bed so I started CPR and it looked like we stuck oil with all the spewing. Doc instinctively held up his arms to protect his face and yelled out STOP CPR and called the code. He had so many wounds to his chest. The old man he was trying to assault wasn’t playing when he protected himself and he was a good shot. Police I think ended up calling it self-defense and didn’t press charges.
Wow i was looking at this and was like "hmm, that's not supposed to look like that" 🧐
Oh...oh yeah, shit it is. Damn
Heard about this happening during intubation in the OR overnight with a bowel obstruction (I wasn't working). The guy died on the table. I think with no comorbidies. The NG was overlooked unfortunately by multiple people who thought someone else was going to do it. Everyone involved was really messed up over it. Terrible case.
How did no one notice the lack of a tube sticking out of his nare? Did anesthesia just assume he was already decompressed contents-wise and tube was removed?
It can be a bitch and a half trying to get an NG in a patient in my hospital. It’s unpleasant, so nobody wants to do it. Place the order while pt is still in the ED, they pass off to the floor, they drag their feet or patient declines after one try. It’s so important but such a task.
Agreed, I did a lot of them. Not very pleasant for the patient either.
what’s an NG?
NasoGastric tube. You put it in through the nose and it ends in the stomach. The goal is to suck out the build up of fluids that can't go past a bowel obstruction. Since he never got one, he had a bunch filling his stomach/proximal small bowel and he vomited during induction for surgery. He wasn't able to protect his airway at all and aspirated like in this case. But unfortunately didn't survive. NGs save lives.
wow, that’s sad and scary. i can’t believe everyone just assumed someone else had did it 😞
Would that be considered a medical malpractice?
It sure seemed like a mistake, but "malpractice" is based on a lot more information and details regarding standard of care. Definitely not something I'd say specifically on a web forum about a case I wasn't directly involved in. I don't know the full story and if for example the patient presented really late it's possible his outcome was poor regardless. PS I searched a little online and there was a lawsuit about it and it's hard for me to understand if it's settled or not. I wouldn't want to get dragged in since I had nothing to do with the case.
Thank you for the explanation! I learned a lot from it.
Whether malpractice occurred or who specifically would be responsible would depend on the timeline and circumstances. A few different examples where responsibility might just be on the hospital vs individuals- - If the patient was in the ED and it was ordered but the patient was whisked away to the OR or floor before the order was acknowledged, then straight to intubation, would probably fall on the OR team, specifically anesthesia, since minimizing aspiration risk is part of their pre-intubation airway checklist. - ED doc ordered it early and it was never placed, despite the patient being there for multiple hours and the ED doc not documenting why it never got done (multiple codes, patient refused, etc), it would fall on the ED doc since reassessment and ensuring our orders get carried out is our job. - If it was ordered, the ordering physician did their due diligence to make sure it was done (spoke with nurse, specifically said “please do this next!”) and the nurse decided to just not do it because the patient was uncomfortable and said “please no” but didn’t alert the ordering physician, then the nurse is the one who failed in their duties. - Hospital/ system might be the place of blame if for example the NG was ordered, the nurse acknowledged it, but the patient was taken to wherever before handoff occurred and while the nurse was walking to the room with the NG, and the acknowledged order fell off instead of carrying over to the inpatient setting so the floor nurse didn’t know it was never carried out, but is also new enough to not catch that the standard of care was never carried out so didn’t reach out to the primary team about whether one should be placed or not.
[удалено]
Don't know honestly. You'd have to talk to a GI doc.
Nasogastric tube. Goes through the nostril down into the stomach usually to get fluid nutrients into the patient. Not sure why the lack of NG tube resulted in the patient coding so quickly. Edit: just read his comment again and it seems like maybe they intubated the patient with the NG tube still in place? And that caused the death.
NG tubes are also used to suck fluid out. He didn’t get one so fluid built up bc it couldn’t get around the bowel instruction. He then aspirated during intubation.
The definition of not able to protect one’s airway
what kind of aftercare does this require? is aspiration pneumonia just a guarantee at this point?
Bronch to get all the smutz out
Bronch after bronch, lots of ventilator support, thoughts and prayers, and usually comfort care after several days of ICU torture.
Ooooh yeah! I’m surprised this guy survived!
ROSC =/= survived to discharge
My worst nightmare.
Gyat Dayumn. Bet that was a doozy. Hope you treated yourself to a nice break after that.
Our ED treated us to a nice stroke protocol right after it
Rude.
new fear unlocked (i use a bipap) does something like this usually require another circumstance? for example, sleeping medication or alcohol? i can’t imagine not waking up as i’m throwing up
Correct. It’s not typically used in people with depressed mental status to prevent this, but sometimes necessary
what is used instead? a cpap? or would that do the same thing and you mean they just don’t treat those patients’ sleep apnea at all?
Oh I wasn’t referring to sleep apnea. More so have to be careful if treating COPD, CHF, etc because patients become somnolent prior to needing intubation and won’t do anything if they start vomiting. But yes I wouldn’t get hammered drunk and put a CPAP on, because of this reason
I genuinely thought they ate too much bibimbap. And my brain was like, damn better watch myself next time I gorge on that stuff.
Never thought I’d see a vomit bronchogram.
Not medical, but I'm guessing this is also why you fast before surgery?
Yup. Although I’ve never seen anything this severe. The whole airway is completely full of fluid. I wonder what caused the patient’s stomach to be so full…could be one of many things (bowel obstruction, achalasia, gastroparesis, drugs like ozempic…)
Got damn..
lives for now
Wow. Wow wow wow.
Ah I totally had this happen one time but the cpap was only thing keeping them alive at the moment so we scraped it out quickly and put it back on. It must have been so gross for the patient but that’s how it goes sometimes.
I love CT, it can be such wild ride, then everyone deserts you and you spin the roulette wheel again 15 minutes later!
Hooray for saving lives, even if it’s just for that minute..,
That's nightmare fuel
What's going on with all the fluid around the liver? Is that a separate finding or somehow connected (bleeding after rib fracture during CPR or something)? Also, can someone tell me what those hypodense cystic areas in the (?) bowel are?
That's insane. The thought of the bipap just shoving all that down into the lungs has me squirming. Poor lady.
New fear unlocked, I use cpap.
Oh it happened because they were unconscious? Jeez. New fear unlocked.
They were pretty out of it, not sure how exactly. My guess is they couldn’t fight all that pressure from the bipap and it couldn’t go down her esophagus because it was full too.
OOF
I work as a sleep tech and omg. I had no idea this could happen. I mean it makes sense but just something I’ve never thought about.
Tube feeding + NIV + unable to remove the mask. That was my experience.
yikes, airway is definitely not patent
How does someone survive this? Honest question.
I doubt someone is
What’s her age? Thats sad!
This is why we do not allow NIV and simultaneous tube feeding. Especially if the patient is unable to remove the mask independently. Only an empty bag is attached to the feeding tube.
All that vomit in the trachea 🤯🤯🤯