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- Mar 15, 2011
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case.
68 y/o pt on the MICU service (mine till Monday when I went off service so these events are from my co-resident who took over the service this week.)
H/o Diastolic failure, bad emphysema, OSA, poor respiratory reserve. Intubated for COPD flare and resp failure about 10 days ago by me. Relatively straightforward airway. Failed 4 consecutive weaning trials last week into weekend. Family finally agrees to trach.
Surgeon comes for perc trach at bedside planned for yesterday. Bronch guided by one of the pulmonologists, who was not the MICU attending that day, just pulm consult. one of the hospitalists who fills in because no one else will was on for the week as the ICU attending.
Trach starts. short, fat neck. apparently he was putting in a size 10 shiley. sats start to drop within the first few min. Bronchoscope is in via ETT , wire is able to be visualized. Pt codes. PEA arrest. Surgeon cannot get trach in. apparently airway is lost, not sure if tube is retracted to far or what. Anesthesia called, cannot reintubate. CPR proceeds for over an hour. eventually called.
When I heard the code I came down to lend a hand, im on a consult service, see like 845 people in the room atleast 6 of whom were physicians so I went back up to my boring renal failure consult.
In that room was the CRNA and anesthesiologist, who also happens to be a boarded ENT, 2 general surgeons, the ICU PGY3 (IM), 2 interns, the MICU attending (hospitalist this week).
Surgeon who was performing the trach gives all of the orders during the code. Asystole and PEA are shocked multiple times. Atropine is given for asystole. Vasopressin is given more than once. code not called till he had a bedside echo done showing immobile ventricles. Basically an hour or more long completely non-ACLS compliant CPR attempt.
I asked the hospitalist why he didn't assume control. he said, and hes very passive, doesn't like to ruffle feathers, but is the listed primary in our closed unit, well it happened during a surgical procedure so I deferred to the surgeon.
Who should be running this code? Is MICU attending liable for the bad outcome as protocol was not followed at all in this case as they were in the room and are the primary attending?
and my guess is huge PE. autopsy pending.
68 y/o pt on the MICU service (mine till Monday when I went off service so these events are from my co-resident who took over the service this week.)
H/o Diastolic failure, bad emphysema, OSA, poor respiratory reserve. Intubated for COPD flare and resp failure about 10 days ago by me. Relatively straightforward airway. Failed 4 consecutive weaning trials last week into weekend. Family finally agrees to trach.
Surgeon comes for perc trach at bedside planned for yesterday. Bronch guided by one of the pulmonologists, who was not the MICU attending that day, just pulm consult. one of the hospitalists who fills in because no one else will was on for the week as the ICU attending.
Trach starts. short, fat neck. apparently he was putting in a size 10 shiley. sats start to drop within the first few min. Bronchoscope is in via ETT , wire is able to be visualized. Pt codes. PEA arrest. Surgeon cannot get trach in. apparently airway is lost, not sure if tube is retracted to far or what. Anesthesia called, cannot reintubate. CPR proceeds for over an hour. eventually called.
When I heard the code I came down to lend a hand, im on a consult service, see like 845 people in the room atleast 6 of whom were physicians so I went back up to my boring renal failure consult.
In that room was the CRNA and anesthesiologist, who also happens to be a boarded ENT, 2 general surgeons, the ICU PGY3 (IM), 2 interns, the MICU attending (hospitalist this week).
Surgeon who was performing the trach gives all of the orders during the code. Asystole and PEA are shocked multiple times. Atropine is given for asystole. Vasopressin is given more than once. code not called till he had a bedside echo done showing immobile ventricles. Basically an hour or more long completely non-ACLS compliant CPR attempt.
I asked the hospitalist why he didn't assume control. he said, and hes very passive, doesn't like to ruffle feathers, but is the listed primary in our closed unit, well it happened during a surgical procedure so I deferred to the surgeon.
Who should be running this code? Is MICU attending liable for the bad outcome as protocol was not followed at all in this case as they were in the room and are the primary attending?
and my guess is huge PE. autopsy pending.