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Sunday, December 11, 2011

Anesthesiology Case - Medical Malpractice



Anesthesiology Case - Medical Malpractice


After any major chest or abdominal surgery, the patient has pain, may not be able to cough well, and may develop pneunonia. The doctor has to be sure that the patient is breathing properly, has physical therapy for the chest problems, or suction of the throat and trachea if needed. A tracheostomy, which is a cut in the windpipe, for direct and frequent suctioning of chronic lung patients, should be performed when indicated. If their lungs are failing, they should be given adequate oxygen by putting them on a respirator (ventilator). All these are parameters which have to be reviewed with regard to postoperative care of patients.

In anesthesia, the critical thing is management of the airway. Was a tube placed into the trachea, (windpipe) properly and immediately and connected to the ventilating machine? Was oxygen given? Was nitrous oxide, a gas anesthetic, switched on instead of oxygen? Was the proper anesthetic gas given? Was the patient given sufficient oxygen? When there is a complication and the patient was not getting oxygen, did the surgeon notice during surgery that the red arterial blood was turning blue? Was the blood changing color? Were the fingernails in a female patient void of nail polish so the pinkness of the oxygen content of the blood could be seen? The doctors have to be able to monitor the patient properly and if there is a complication, to recognize it in a timely manner.

Many complications of anesthesia in an operating room are preventable. If the patient was placed on his side for kidney surgery, for example, the operating table is bent and a "rest" (an elevation) is pushed up to bend the patient by stretching the muscle from the hip to the rib area, or in chest surgery, under the upper chest to stretch the ribs apart, were the patient's nerves protected under the armpit region? Did the patient wind up with paralysis of the arm? Was their spinal cord so flexed that they became paralyzed? Or, were they lying down on their back with their arms overextended up over the head and the brachial plexus, the nerves to the arms, overstretched? It's negligence. Was the elbow protected? Did they get ulnar nerve damage at the "funny bone" area causing a claw hand? Was the elbow crushed against the metal edge of the operating table and not protected properly? It's negligence. Yes, it is res ipsa loquitur, but you need to have an expert testify that it did not happen in your case in the absence of negligence. It's a medical malpractice case needing analysis and testimony on negligence, causation and damages just as every other case.

Proper positioning of the patient in the operating room is the responsibility of the anesthesiologist, nurse, operating room technician, assistant surgeon and surgeon. Never forget that there is an assistant surgeon, often with his or her own insurance policy, who should be sued. Also, do not overlook each of the anesthesiologists (there are several because they take shifts during long anesthetics). Anesthesiologists, the hospital, the surgeon, the assistant surgeon, and all of the corporations associated with these entities, should be defendants.

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.

Misdiagnosis of a Heart Attack



Misdiagnosis of a Heart Attack


A heart attack (myocardial infarction) is the most common cause of death in both men and women. Failure to timely treat will result in further irreversible heart damage with the consequence of heart failure, or worse: death. Classical crushing chest pain is most common in men, but not in women(who more commonly experience jaw, back or arm pain, or just fatigue).

Whenever any adult has symptoms of a heart attack, the following test must be performed: an electrocardiogram (EKG), plus blood enzyme test to rule out heart muscle injury (troponin and CPK). Even if these are initially normal, the patient should be monitored in a hospital for 24 hours, and retested, especially if they have high risk factors: a previous heart attack, high blood pressure, diabetes, high cholesterol (especially if their LDL {“lousy” cholesterol} is greater than 100), and if they have a family history of a heart attack. The failure to do this is a departure from the accepted standards of care.

Whenever a heart attack is diagnosed, the best treatment is to use blood clot dissolving medication (tPA: tissue plasminogen activator) within 4 hours to reopen the blocked coronary artery before irreversible heart muscle damage (necrosis: gangrene) occurs. Furthermore, continuous EKG monitoring will allow immediate treatment of any irregular heart rhythm (arrhythmias) before they cause ventricular fibrillation (just twitching of the heart muscle, without any blood pressure being created). Electrical defibrillation (electric shock to the heart) when immediately performed can often restart the heart, saving the patient’s life and brain before irreversible damage results.

If the patient sustained a heart attack and was negligently misdiagnosed, but did not die, the psychological damage can be extensive: heart muscle damage with some degree of heart failure: decreased cardiac pumping efficiency measured by a lower ejection fraction, plus higher risk for a fatal heart attack, and greater need for invasive procedures: angioplasty or coronary artery bypass graft (CABG), with their risks and expenses.

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.

Monday, December 5, 2011

Lung Cancer Misdiagnosis Malpractice Case



Lung Cancer Misdiagnosis Malpractice Case


Lung cancer: does the patient have cancer or is that scar tissue in the lung from tuberculosis or something else? The doctor has a duty to obtain any previous chest x-rays. If this is a "new lump" seen in the lung and the patient had a chest x-ray a year before and five years ago, which showed the same lump, it couldn't be cancer because it hasn't changed. How was the patient evaluated before surgery? Bronchoscopy, looking into the windpipe, and obtaining sputum specimens for germs and cancer analysis is important. The condition must be properly diagnosed, biopsies performed when possible, the patient told about the risks, and the previous chest x-rays checked. Very often we see negligence in failing to examine earlier x-rays, whether they were taken for tuberculosis screening, for work physicals, for insurance, for previous hospitalizations, or for any other condition. Have good copies made of all x-rays. Was the lump seen earlier? Was it misdiagnosed when the cancer cure rate would have been higher? Has it changed? Is it cancer or was it some old scarring, tuberculosis or pleurisy? Lung cancer is one of the top five diseases in terms of malpractice dollar awards. The typical case alleges misdiagnosis via poor diagnostic methods or mismanagement of diagnostic tests. Delayed diagnosis of lung cancer offers a much poorer prognosis, and therefore any malpractice award is typically large in terms of dollar value.

This medical malpractice article was written by an expert witness working with American Medical Experts, LLC (AME). AME is the nation’s leading source of medical experts for case review and testimony; AME also offers the lowest flat rate fees on Complete Case Reviews ($695) and Expert Witness Reports ($995). For more information, call 888-678-EXPERTS (888-678-3973) or visit AmericanMedicalExperts.com.