Are you kidding me!?! I mean, without the CXR we can only speculate what happened, but this "expert witness" is a total clown! First of all they don't even understand what barotrauma means and is using that term inappropriately which makes me wonder if they are an idiot. Then they make this wild accusation that the doctor should have gotten a CT which confirms that they are, in fact, an idiot.
Well it's all about money. Medical "expert" witnessing is a form of bribery. Look at the bills - do a few of these a year and you got yourself a new kitchen in no time. Pay me enough green and I'll tell you the sky is green. This is why the system needs reform.
I'd much prefer an impartial panel of experts that reviews cases than our current "buy an expert" scheme. Important they DO let some cases through when true malpractice has occurred, but also that they block a lot of the ridiculous cases.
If I were the defendants lawyer my questioning towards the radiologist would have been along the lines of how many pneuomothoraces they have diagnosed, how he can tell it is a tension pneumo on the film. How many pneumo's has he treated? How many chest tubes placed? How often a simple converts to a tension. How often a tension pneumo results from a central line. How often a copd bleb looks like a pneumothorax. What can happen if a chest tube is erroneously placed in a bleb etc. He was the wrong plaintiff's expert for this case. Can't comment within reason beyond the radiographic interpretation. I would even argue if the icu doc could read the xray why are radiologists needed? Wasn't it the radiologist who missed the ptx and failed to communicate with the icu attending?
As an Interventional Radiologist, I have done hundreds if not thousands, of central lines in my career, most with US guidance. Pneumothorax after IJ placements is exceeding rare, in fact I don't not recall ever having one. Theoretically it is possible with a blind attempt in a low position and "burying" the needle.
Post procedure CXR in IJ catheter placement is done to verify tip position rather than to evaluate for pneumothorax, and is not necessary if the procedure was done with fluoroscopic guidance. CT is indicated only if the position of the line is in question on the CXR.
The expert could have been correct in that the pneumo was produced by barotrauma, but in an ICU patient that would be due to positive pressure ventilation, not the attempted IJ placement.
Are you kidding me!?! I mean, without the CXR we can only speculate what happened, but this "expert witness" is a total clown! First of all they don't even understand what barotrauma means and is using that term inappropriately which makes me wonder if they are an idiot. Then they make this wild accusation that the doctor should have gotten a CT which confirms that they are, in fact, an idiot.
Well it's all about money. Medical "expert" witnessing is a form of bribery. Look at the bills - do a few of these a year and you got yourself a new kitchen in no time. Pay me enough green and I'll tell you the sky is green. This is why the system needs reform.
I'd much prefer an impartial panel of experts that reviews cases than our current "buy an expert" scheme. Important they DO let some cases through when true malpractice has occurred, but also that they block a lot of the ridiculous cases.
If I were the defendants lawyer my questioning towards the radiologist would have been along the lines of how many pneuomothoraces they have diagnosed, how he can tell it is a tension pneumo on the film. How many pneumo's has he treated? How many chest tubes placed? How often a simple converts to a tension. How often a tension pneumo results from a central line. How often a copd bleb looks like a pneumothorax. What can happen if a chest tube is erroneously placed in a bleb etc. He was the wrong plaintiff's expert for this case. Can't comment within reason beyond the radiographic interpretation. I would even argue if the icu doc could read the xray why are radiologists needed? Wasn't it the radiologist who missed the ptx and failed to communicate with the icu attending?
As an Interventional Radiologist, I have done hundreds if not thousands, of central lines in my career, most with US guidance. Pneumothorax after IJ placements is exceeding rare, in fact I don't not recall ever having one. Theoretically it is possible with a blind attempt in a low position and "burying" the needle.
Post procedure CXR in IJ catheter placement is done to verify tip position rather than to evaluate for pneumothorax, and is not necessary if the procedure was done with fluoroscopic guidance. CT is indicated only if the position of the line is in question on the CXR.
The expert could have been correct in that the pneumo was produced by barotrauma, but in an ICU patient that would be due to positive pressure ventilation, not the attempted IJ placement.