A 47 yo female was awarded $30 million to recover past and future medical costs, lost wages and pain and suffering for complications of treatment of septic shock by a Florida court.A plastic surgeon performed a "tummy tuck" (abdominoplasty) in 2001, soon after that the patient began to to have fever. According to the newspaper story, she went to the ER and the on-call surgeon "removed some fluid from her stomach area and... she was given medicine that focused blood flow to the inner part of her body to protect her vital organs.
Yerrid said this medicine can be given only after fluids have been administered; otherwise, the flesh in the extremities will die. Haedicke never ordered fluids for Lucia.
Haedicke's attorney said Lucia's kidneys were shutting down. Had he administered fluids, she could have died.
The lack of blood flow to her extremities had caused severe damage to her hands and legs. Doctors at Tampa General were forced to amputate fingers from both hands and her legs below both knees."
Of course, it is difficult to impossible to comment on a medical case without examining the patient and reviewing the chart but we usually give IV fluids (IVF) before and during pressors administration.
The rationale of "filling the tank" before using pressors (which can cause peripheral ischemia) is well-illustrated in this clinical case: Pneumonia and Septic Shock. As you can see from the labs, this patient also had acute renal failure which actually improved with IVF.
Early rapid and appropriate treatment of septic shock is extremely important in order to decrease morbidly and mortality in this very sick patient population.
References:
Patient Wins $30 Million. The Tampa Tribune, 5/2007.
Pneumonia and Septic Shock. ClinicalCases.org.
Link via Kevin, M.D.
Image source: CDC, public domain.
A critical question I haven't seen addressed is how long she would have to have gone without treatment in order for the infection to reach such a critical point. Is there some responsibility on her part having not sought treatment when at the first sign of fever?
ReplyDeleteThe standard treatment for septic shock is usually fluids in combination with pressors. I would like to know if they had a CVP or, even better, a PCWP prior to initiating treatment. With active sepsis, these were quite probably low.
ReplyDeleteI don't buy the "fluids would have caused her kidneys to fail" argument. If anything, the opposite is true. Most pressors, an exception being dopamine at low doses, decrease renal blood flow via vasoconstriction. Add hypovolemia and renal blood flow will be further compromised.
Hypotension management 101: you need to "prime the pump" before adding pressors.
Obviously, we don't have the full story here. But, given this history, it is a mystery as to why no one hooked up an IV bag to this patient.
I am sure they did administer IV fluids, they just failed to document it.
ReplyDeleteIV fluids were given. Almost 8 liters in the first 12 hours. 3-4 liters were on board before the pressors were started. The issue was whether she had as much fluid as she could take, with a subsequent treater stating that 10-15 liters would not be unusual.
ReplyDeleteHi ,
ReplyDeleteThanks for posting the article , which again raised the hopes of the victims and their family members .
One of the good example for all of us .
With best regards ,
Lorra .