"You will kill the patient doing that!!!"

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Veneficus

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OK,

I know at some point in our careers either in school or at work, most of us have been confronted with this piece of "wisdom."

I think it is time for a discussion.

I am sure not many are going to come forward and say "I killed my patient doing..." and I would expect anyone to.

But how many here have witnessed first hand an intervention that directly resulted in the death of a patient?

I don't mean "we had a really sick patient and in the treatment options we chose to do X and the patient died," or "we found a dying patient who we couldn't figure out what was wrong with him and the patient died." Not even "we probably should have done X but didn't."

I mean a certified confirmed kill.

Now I am willing to bet a few people intubated an esophagus. But if you were intubating, was RSI performed, or was the patient so far gone that the patient could be intubated without pharm aid?

Defib something other than v-fib or pulseless v-tach?

Push a lethal med dose or an absolute contraindicated med?

How soon after did the patient die?

What was done to fix it?

Who noticed?

Did anyone find out/ get disciplined/sued etc?

Finally what have you been told would result in you killing a patient?
 
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Well, as I mentioned in my other thread...I was told that if I put a BP cuff on the arm where a patient had a renal dialysis shunt...it would have killed him.
 
Gymchick said:
Well, as I mentioned in my other thread...I was told that if I put a BP cuff on the arm where a patient had a renal dialysis shunt...it would have killed him.
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yea, that is what spawned this thread.
 
I'm not quite sure what you're asking. Are we supposed to speak about a med, neglect, or intervention error that resulted in a fatality (llike maybe giving atropine for cx pain, morphine for a Sz, etc.), or having a somewhat stable pt die from a proper intervention?

Personally, I haven't killed anyone due to clinical error. When I was a medic student, my preceptor and I killed a 26 y/o male by cardioverting unstable SVT into asystole. I also rendered a 56 y/o male unconscious and in a slow idioventricular PEA after a Sz following ntg admin (got him back and also relieved his cx pain LOL), but I don't think these two examples cases are what you were asking for.
 
I've been told all sorts of crap will kill a patient, or take away a physicians assesment ability, ect, ect, ect. Mostly when you dig a little your intervention being described that way is inconvient/scary/not what the staff at a recieving facility is used to.

My one confirmed kill was an adult CF Pt in respiratory failure, sats in the 70s and ETCO2s in the 90s while being BVM'd with 10 of PEEP and an FI pretty dang close to 1.0. Yet due to his long history with the disease process he was still conscious. Attempted intubation with just Etomidate, resulted in trismus. Pushed Rocc and ended up with the pt deterorating into PEA in the 25 sec it took to place the tube. Worked for 20min, called on ED arrival. Reported immediately to the clinical department. We had a call review, during which it was decided the only other course that would have been a cric when the trismus was observed. The whole thing was chalked up as an educational issue.
 
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I've been told that "that will kill the patient!" so many times about various things, I've lost count. Funnily enough, it never has!

I think in hindsight I have done a lot of damage to patients in the pre permissive hypotension era, squeezing as much crystalloid and colloid into patients as I can to get to a "normal" blood pressure.

My only justification is that it was the accepted standard of the day ;)
 
Long ago, I heard that giving a COPD pt supplemental O2 would kill them by knocking out their respiratory drive, pretty much right away. J/K. Please don't anyone go off on a 32 post hypoxic drive tangent, as there are several previous threads addressing that topic.

I've also heard that if you don't board and collar everyone that c/o traumatic neck/back pain, even if it was a parking lot MVA w/ only paint transfer, they could turn to look at something, sever their spinal cord, collapse and die. It matters not if the spinal motion restriction process causes more damage. We're saving lives, damn it!

Seriously, I was once told that all medications have the potential to kill. That might be a bit of exaggeration, but the point is to not empty your box of wonder drugs just because you can, according to the cookbook. I can think of more than several examples where relatively benign drugs such as dextrose, oxygen, and NS can potentially cause great harm or kill the pt.

I've been told that giving ntg without a line to the pt w/ inferior changes, unless the V4R checks out, can kill them.

I've been told that failure to suppress multifocal PVC's can leave the pt at risk of R on T, sending them into V-Fib, if the myocardium is sufficiently stimulated during the relative refractory period. It's why we cardiovert rather than defib SVT/ V-Tach w/pulse.
 
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Smash said:
I've been told that "that will kill the patient!" so many times about various things, I've lost count. Funnily enough, it never has!

I think in hindsight I have done a lot of damage to patients in the pre permissive hypotension era, squeezing as much crystalloid and colloid into patients as I can to get to a "normal" blood pressure.

My only justification is that it was the accepted standard of the day ;)
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Yeah, we used to dump in up to 6 liters of NS. Matter of fact, I just looked up the NYC REMSCO ALS Non-Cardiogenic Shock protocol (515), and it hasn't changed. Give 3 L, and call for 3 more if no change.

http://www.nycremsco.org/images/articlesserver/ALS_Protocols_January_2010_v01012010d.pdf
 
laying a chf'er flat ---> flash edema--> resp failure?

that's always the trotted out example about why it's so important to check lung sounds on every single pt...

:shrug:
 
That NYC Protocol book will kill you! Seriously, up to six litres of fluid for shock and a KVO rate of IV fluid for pulmonary edema? OMG!
 
46Young said:
Yeah, we used to dump in up to 6 liters of NS. Matter of fact, I just looked up the NYC REMSCO ALS Non-Cardiogenic Shock protocol (515), and it hasn't changed. Give 3 L, and call for 3 more if no change.

http://www.nycremsco.org/images/articlesserver/ALS_Protocols_January_2010_v01012010d.pdf
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wow...we don't even have near that much fluid on the trucks. if we run a 500 bag wide open and we don't make it to the ER before its gone somethings wrong. I think theres about 20 hospitals within 15 min of where im sitting right now and the areas i work in were only about 5-10 min max of 3-4 of them with 2 of those being level 1 trauma centers.
 
I have yet to play reaper (that I know of :rolleyes:) But have seen it "firsthand". We had a 60 y/o code, initially PEA --> Asys -->VFib began transport, got him to the hospital with pulses intact. Pt. deteriorated again after central line was placed at ED. VTach with pulses, doc ordered a shock, I observed the RN setting the monitor up for a shock, and against my objections proceeded to DEFIB the pt. twice at 200J. No sync...pt. snapped right back to asystole. Nothin' pisses me of quite as much as workin a pt. and then having them lost due an a stupid negligent error.
 
Well, what can I say! I'm working on 2 billion served!
 
I've been told the COPD one too - never lay them flat, and be very careful about giving them oxygen because of the hypoxic drive.

Also, don't suction more then 10 seconds or the patient will suffocate because you've sucked all of their oxygen out. (That one is from class.)

Also, don't look in the mirror and say "Candyman" three times in a row.
 
MrBrown said:
That NYC Protocol book will kill you! Seriously, up to six litres of fluid for shock and a KVO rate of IV fluid for pulmonary edema? OMG!
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The protocol is for non cardiogenic shock, but still....
 
RUGBY66X said:
wow...we don't even have near that much fluid on the trucks. if we run a 500 bag wide open and we don't make it to the ER before its gone somethings wrong. I think theres about 20 hospitals within 15 min of where im sitting right now and the areas i work in were only about 5-10 min max of 3-4 of them with 2 of those being level 1 trauma centers.
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We're only permitted to give two 500cc boluses in general, and we also have the 70/90 Sys. permissive hypotension guidelines as well.
 
Quite a while back, we were nosing around in the monitor's archives and found a code summary from a cardiac arrest. The patient was in a sinus rhythm, and the provider defibrillated him 3 cute little times. He was dead after that.

I've heard of a lot of stupid mistakes that only increased morbidity, but not actually killed the patient.

In my personal experience, we had a close encounter with disaster when I had a preceptee who had drawn up 2 mLs of Dopamine instead of Ativan for a seizing patient. I should have been checking the vial behind her, but I didn't...the only reason we caught it is because we talked about how thick the Ativan was and how difficult it is to pull up into the syringe. The preceptee said, "No it isn't, it was easy." So we checked the vial and it was dopa. That's when I almost died. She had the syringe in the IV line about to push it when we figured it out.
 
you will kill the patient if you dont take that NRB off while switching to the main oxygen!11!!!11!
 
46Young said:
The protocol is for non cardiogenic shock, but still....
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Non cardiogenic shock as in septic shock, for example, as opposed to "I have a knife in my belly" shock? It doesn't sound unreasonable for the first, somewhat horrific for the second!
 
Gymchick said:
...Also, don't look in the mirror and say "Candyman" three times in a row.
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Three times in a row is fine...it's the fifth time you have to watch out for. ;)
 
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