The Lewis Blackman Case Case Study

It is widely known that early recognition of a deteriorating patient can contribute largely to a successful outcome, through recognising and taking action on the deteriorating health status of the patient (National Consensus Statement, 2010). This report will explore the ways in which deteriorating patients and clinical reasoning are used in the public health care system in New South Wales (NSW).

In February 2013, a forty-eight years old male with no prior co-morbidities transferred from Quetta to Aga Khan University Hospital, Karachi after sustaining multiple lacerations and left tibia bone closed fracture in a bomb blast. After initial management in the hospital, he underwent an orthopedic procedure (application of illiazarov over left tibia) under general anaesthesia. The surgery went uneventful, and he then shifted to ward. From next day morning, he suddenly developed dyspnea and became hypotensive and tachycardiac (respiratory rate about 40/min, pulse 140 beats per min and blood pressures were around 60/30). He was barely maintaining oxygen saturation 90% on 10 liters of O2 via facemask. Initially, he was given 2 liters of fluid bolus but hemodynamics did not respond. A few minutes later, he went into pulseless electrical activity and

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

We know that he had sustained an at home fall. We learn that he has a history of pain and a prescription for oxycodone for back pain. We know that his vital signs on admission appear stable; he was not showing any signs of respiratory distress. As we look at the staff that was listed that day we do get the sense the hospital may have been short staffed. Staffing report shows there was one MD, one RN and one LPN managing at least 4 patients including- one patient was a child. Evidence based research has proven that the nurse to patient ratio is directly related to the patient outcomes (Stanton, 2004). It is important that we consider the staffing level that this rural ED as we know short staffing can be blamed for not being able to take the full amount of time needed to do a proper health history. A detailed health history is an imperative part of the care process; it is used by the staff to accurately assess any acute changes that may take place in the patient throughout their stay.

The medicinal experts on staff for the 12 hours that the patient was in painful distress while she was being drowned by the feeding solution, neglected to perceive that she was in trouble until it was past the point of no return. While this is obviously a blatant case of medicinal negligence, not all medical malpractice cases are quite so obvious, and not every single medical procedure with a troublesome result can be viewed as medical malpractice negligence. The essential prerequisite for medical malpractice is that the doctor or other medical expert has breached the acknowledged standard of care for their specialty in their geographic area, and that the breach caused harm to the patient. Doctors, as human beings, commit errors consistently, yet in the event that their mistake does not bring about injury or harm to the patient, there are no grounds for lawful

There are errors and hazards in care that occurred in the Mr. B scenario. One error was the emergency room physician’s failure to recognize the signs and symptoms of deep vein thrombosis (DVT) that Mr. B was presenting. If not treated early, a DVT can become a pulmonary embolism, a fatal condition that Mr. B unfortunately developed. Another error in care that happened in the Mr. B scenario is the nurses’ failure to monitor Mr. B’s ECG and respirations. Early detection of critical ECG and respiratory changes could have initiated medical interventions that would have saved Mr. B’s life. One hazard is the emergency room nurses’ heavy patient load at the time of Mr. B’s sentinel event. Another hazard is having a licensed

The bad thing about the situation was that medically there was nothing more that could be done for this patient. All the family could do was to sit by his bedside and wait for their loved one take his last breath, and to be at peace.

I was also surprised to see a comatose patient gain consciousness after 35 days. As a part of a team caring for this comatose patient in the ICU, I was involved in monitoring his vital signs, airway, nutrition and urine output. I worked closely with other members of the health care team to maintain his physical health. Swithching him form oropharyngeal ventilation to cricothyrotomy for airway management was another challenging task caring for this patient. I built a good rapport with his family members as I communicated

Information that is missing in this particular case in the lack of education to the medical staff

My name is Tremain Lewis and I am the Client Success Manager for TeleTracking assigned to Christus Health. I have attached the our CSM data sheet for your review. Tori Rodgers in Marketing Department forwarded over your information and when you get an opportunity to please give me a call.

This can be read as a key ethical question to many healthcare case studies because of the errors and situations that occur. One of the explanations for this occurrence may be the overwhelming workload, chaotic environment and lack of individual attention prescribed to each patient. These issues can cause a disruption to the ethical principle of Beneficence. The principle of Beneficence calls to action the act of helping others and having compassion for the patients. This principle can be threatened when a doctor or caretaker is overworked and unable to effectively manage the series of patients and work they are assigned to take on. I believe that the admitting doctor did not initially catch the error of not calling for the specific drug need because he was more focused on getting Mr. Londborg stable and on the medication to treat his initial and present condition before worrying about the preventative medication. In addition, the doctor was so focused on helping everyone all at once that he was blind to the small details and loose ends that needed to be taken care

Unforeseen events will always be a risk that can accompany those receiving medical care. One way that these risks can be minimized is through the creation of a risk management team. Risk management teams serve to protect the interests of all parties involved in terms of patient services and privacy, costs, and most importantly, patient safety. They strive to control unsafe events from occurring by being proactive in care rather than being reactive to any given situation. This paper discusses the circumstances regarding T.G.’s care and the events that transpired before his untimely death.

After reading this scenario about this patient, there are a few things that I wonder about and things that could have potentially contributed to this patient’s death. First, I do not understand why they did not place an Ewald tube down this patient and perform some sort of gastric lavage with activated charcoal (Gastric, 2017). They did all the work to stabilize the patient, but did not remove the remainder of the product, causing the acidosis. Basically, I feel that the patient came in with metabolic acidosis because of the aspirin, was stabilized, but then developed metabolic acidosis again. Which could have lead to a whole new list of complications to develop.

What are the risks for patients that are severely ill? What are the long-term effects? Is there any evidence? You have to weigh different aspects.”3

In response to the poliomyelitis epidemic in 1950, the specialty of critical care medicine came into existence (Wenham & Pittard, 2009). Accordingly, the significance of critical care medicine has expanded since the inception of this specialty and has vigorously been revolutionized with the emergence of highly developed and sophisticated technology to support the critically ill patient (Wenham & Pittard, 2009). These clinical and technological advances in critical care medicine have enhanced the preservation of life, although,