This crap needs to be submitted to ABEM for censure. The only way to get them out of the game is to make it where no attorney can use them as an expert.
It would have been interesting if the defibrillation outcome would have succeeded if the new guidelines recently adopted by New Zealand, i.e., the double shock technique using first the pads in the usual position followed by a shock through a second set of pads with one on the back, were used.
It is not clear for how long he was in cardiac arrest on the third arrest. It is not even clear if the patient was bag valve ventilated during all this resuscitation effort . ACLS protocol always emphasize that intubation is not any better than non invasive ventilation , since he was already sedated and paralyzed i asume he was Ambu bag ventilated all the time. We don’t know much about the placement quality of the I gel ( laryngeal mask). It is common to see some degree of anoxic brain injury after three cardiac arrest. We don’t know how bad was his anoxic brain injury we can only asume that it was severe enough when family decided to withdraw and de escalate care.
sorry med mal reviewer - I disagree about whether the failed intubation caused the injury. Neither the recoverable LV dysfunction nor having an IABP placed would cause irreversible anoxic encephalopathy. There was clearly an issue resulting from either prolonged v-fib arrest or inability to intubate the patient - we would need more information on the code to adjudicate whether the arrhythmia was responsible or primary anoxia.
I do have an issue with criticizing the use of paralytics - this is clearly indicated here - but the EM physician had no plan for a backup airway. An LMA as inserted by EMS providers or a cricothyroidotomy would have been life saving here.
Dios Mio, I was reading the expert witnesses statements and my jaw just dropped... Then I read your comment and finally I can breathe again! Thank you for your (to my opinion) great assesment!
Btw to sue a doctor like this in Germany, you have to prove that the patient would have had a better outcome, if Intubation was without complication. Which would be impossible.
The defense attorney should start the expert cross-examination by showing him the written guidelines and policy, then the next question have you ever had a difficult intubation? And the continue to
Destroy the dude until he decides that it is easier to sell Girl Scout cookies for an extra dollar.
Unfortunately their
board certification and licensing can't be challenged ( only during Covid😂)
While the opinion and reasoning from the plaintiff's experts is clearly flawed, I wish we had more information about how many times intubation was attempted and if the patient was successfully oxygenated via BVM between attempts. The argument that "paralyzing a patient and being unable to intubate" should never happen is just not realistic because it certainly does occur in difficult airways. Failed tracheal intubation in itself is not life threatening, as far as ventilation via BVM is adequate. In this kind of event, it's important to remember the goals of failed airway management.
A failed airway occurs after 3 unsuccessful intubation attempts. During each attempt, something should be changed from previous failure to improve the chances of intubation and a backup plan should be ready. I don't understand why the ER physician did not place a LMA after the previous failures. The case states the LMA was placed by EMS when they arrived. If for some reason a LMA could not be placed, a cricothyrotomy should have been performed.
If the documentation shows that the patient was being successfully ventilated by BVM, it's a moot point. Clearly a patient who has multiple cardiac arrests will suffer a degree of anoxic injury even with an airway. I'm glad the defense has strong experts and hopefully there is additional information in the charting about BVM oxygenation and VS during the event.
It is not clear for how long he was in cardiac arrest on the third arrest. It is not even clear if the patient was bag valve ventilated during all this resuscitation effort . ACLS protocol always emphasize that intubation is not any better than non invasive ventilation , since he was already sedated and paralyzed i asume he was Ambu bag ventilated all the time. We don’t know much about the placement quality of the I gel ( laryngeal mask). It is common to see some degree of anoxic brain injury after three cardiac arrest. We don’t know how bad was his anoxic brain injury we can only asume that it was severe enough when family decided to withdraw and de escalate care.
This is a discouraging lawsuit. Anytime an ER doc decides to take an airway, there is the risk you may not be able to intubate successfully. Any competent ER doc could find their self in this exact same scenario. It is disheartening that the plaintiffs blame the ER doc for his death and not the massive heart attack. Anyone else suspicious that the patient's family heard something along the line of "Mr. X would have been alive if the intubation went better" from a cardiologist or a CICU nurse?
Crazy to blame the ER doc for the bad outcome. But if ya miss a tube, you put the LMA in. Then you probably could bogie through the LMA tbh. Don’t hand a failed airway over the EMS. That just looks bad doesn’t it. Some devastated family looking for someone to blame will get you.
This is a hideously egregious expert testimony and needs to be submitted for censure. This won't stop until us, as a collective of reasonable physicians, put our foot down and turn in money thirsty immoral colleagues.
It’s just so weird that the EM doctor is getting sued in this case, felt like he did everything he could and everything he should have done , one can maybe he should have put in a crico but if there’s record of the saturation with the LMA, i think he could be okay
Agree with the comments. Unbelievable. Has ACEP actually wielded that censure stick? (I know it is out there...but is it ever used?). And is there a public record/database of that censure?
What strikes me even more, is there is a Plaintiff lawyer who is comfortable with this person being an expert witness.
This crap needs to be submitted to ABEM for censure. The only way to get them out of the game is to make it where no attorney can use them as an expert.
These physician experts selling their opinions seem like real jerks.
It would have been interesting if the defibrillation outcome would have succeeded if the new guidelines recently adopted by New Zealand, i.e., the double shock technique using first the pads in the usual position followed by a shock through a second set of pads with one on the back, were used.
It is not clear for how long he was in cardiac arrest on the third arrest. It is not even clear if the patient was bag valve ventilated during all this resuscitation effort . ACLS protocol always emphasize that intubation is not any better than non invasive ventilation , since he was already sedated and paralyzed i asume he was Ambu bag ventilated all the time. We don’t know much about the placement quality of the I gel ( laryngeal mask). It is common to see some degree of anoxic brain injury after three cardiac arrest. We don’t know how bad was his anoxic brain injury we can only asume that it was severe enough when family decided to withdraw and de escalate care.
sorry med mal reviewer - I disagree about whether the failed intubation caused the injury. Neither the recoverable LV dysfunction nor having an IABP placed would cause irreversible anoxic encephalopathy. There was clearly an issue resulting from either prolonged v-fib arrest or inability to intubate the patient - we would need more information on the code to adjudicate whether the arrhythmia was responsible or primary anoxia.
I do have an issue with criticizing the use of paralytics - this is clearly indicated here - but the EM physician had no plan for a backup airway. An LMA as inserted by EMS providers or a cricothyroidotomy would have been life saving here.
Did they document oxygenation/ventilation between intubation attempts?
Dios Mio, I was reading the expert witnesses statements and my jaw just dropped... Then I read your comment and finally I can breathe again! Thank you for your (to my opinion) great assesment!
Btw to sue a doctor like this in Germany, you have to prove that the patient would have had a better outcome, if Intubation was without complication. Which would be impossible.
This ED physician can and should be turned to the college (ACEP ethics committee), where their egregious “expert“ opinion given under oath from
The case chart reviews are scrutinized but underused. He clearly violated this Policy with an off-the-wall Negligence and Causation;
https://www.acep.org/patient-care/policy-statements/expert-witness-guidelines-for-the-specialty-of-emergency-m edicine.
The defense attorney should start the expert cross-examination by showing him the written guidelines and policy, then the next question have you ever had a difficult intubation? And the continue to
Destroy the dude until he decides that it is easier to sell Girl Scout cookies for an extra dollar.
Unfortunately their
board certification and licensing can't be challenged ( only during Covid😂)
While the opinion and reasoning from the plaintiff's experts is clearly flawed, I wish we had more information about how many times intubation was attempted and if the patient was successfully oxygenated via BVM between attempts. The argument that "paralyzing a patient and being unable to intubate" should never happen is just not realistic because it certainly does occur in difficult airways. Failed tracheal intubation in itself is not life threatening, as far as ventilation via BVM is adequate. In this kind of event, it's important to remember the goals of failed airway management.
A failed airway occurs after 3 unsuccessful intubation attempts. During each attempt, something should be changed from previous failure to improve the chances of intubation and a backup plan should be ready. I don't understand why the ER physician did not place a LMA after the previous failures. The case states the LMA was placed by EMS when they arrived. If for some reason a LMA could not be placed, a cricothyrotomy should have been performed.
If the documentation shows that the patient was being successfully ventilated by BVM, it's a moot point. Clearly a patient who has multiple cardiac arrests will suffer a degree of anoxic injury even with an airway. I'm glad the defense has strong experts and hopefully there is additional information in the charting about BVM oxygenation and VS during the event.
It is not clear for how long he was in cardiac arrest on the third arrest. It is not even clear if the patient was bag valve ventilated during all this resuscitation effort . ACLS protocol always emphasize that intubation is not any better than non invasive ventilation , since he was already sedated and paralyzed i asume he was Ambu bag ventilated all the time. We don’t know much about the placement quality of the I gel ( laryngeal mask). It is common to see some degree of anoxic brain injury after three cardiac arrest. We don’t know how bad was his anoxic brain injury we can only asume that it was severe enough when family decided to withdraw and de escalate care.
This is a discouraging lawsuit. Anytime an ER doc decides to take an airway, there is the risk you may not be able to intubate successfully. Any competent ER doc could find their self in this exact same scenario. It is disheartening that the plaintiffs blame the ER doc for his death and not the massive heart attack. Anyone else suspicious that the patient's family heard something along the line of "Mr. X would have been alive if the intubation went better" from a cardiologist or a CICU nurse?
Crazy to blame the ER doc for the bad outcome. But if ya miss a tube, you put the LMA in. Then you probably could bogie through the LMA tbh. Don’t hand a failed airway over the EMS. That just looks bad doesn’t it. Some devastated family looking for someone to blame will get you.
This is a hideously egregious expert testimony and needs to be submitted for censure. This won't stop until us, as a collective of reasonable physicians, put our foot down and turn in money thirsty immoral colleagues.
Is there any update regarding the case?
It’s just so weird that the EM doctor is getting sued in this case, felt like he did everything he could and everything he should have done , one can maybe he should have put in a crico but if there’s record of the saturation with the LMA, i think he could be okay
Agree with the comments. Unbelievable. Has ACEP actually wielded that censure stick? (I know it is out there...but is it ever used?). And is there a public record/database of that censure?
What strikes me even more, is there is a Plaintiff lawyer who is comfortable with this person being an expert witness.