70-year-old woman with multiple chronic conditions including COPD, coronary artery disease, and chronic back pain. Patient presented on 01/31/2025 to undergo planned elective robotic ventral hernia repair with mesh.
Patient was admitted following this for pain control and dialysis. Nephrology was consulted. On POD#1, she was hyperkalemic and underwent dialysis. Her expected post-op incisional and hernia mesh pain was not well controlled and so she kept for further pain control. Pain management was consulted.
Critically, her medical chart clearly documented allergies to morphine, hydrocodone, and tramadol. Despite this, she was administered morphine via a PCA pump, Dilaudid and Oxycodone accompanied by Benadryl. We presume as prophylaxis to an allergic reaction?
On POD#3 she went back to dialysis. After returning, the patient was noted to have a swollen tongue. Rapid response was called. Hospitalist and surgeon also saw the patient at this time. IV bolus fluids were ordered, supplemental oxygen was applied and decadron as well benadryl were given for tongue swelling.
Tongue swelling improved following medication administration.
Possible allergic causative agents were supposedly discontinued from the patient's MAR.
Following this, later that evening the patient complained to nursing about difficulty breathing once again. Rapid response was again called. Shortly after they arrived the patient had an episode of emesis and then went unresponsive. She lost her pulse and CPR was commenced. Initial rhythm was asystole.
Patient was intubated. CPR proceeded for approximately 20 minutes under the supervision of the on call intensivist. After 30 minutes of CPR, efforts were stopped and the patient was pronounced dead.
Clinical notes post cardiac arrest:
“70 YOF admitted on 1/31/25 with PMH significant for A-Fib, CAD, ESRD, HTN, Hypothyroidism, Obesity, Ileum Perforation, Small-bowel Resection with Ileostomy Creation & Ileostomy Takedown; presented with ventral hernia for robotic hernia repair with mesh.
On 2/3/25 (POD #3), patient developed tongue swelling, difficulty breathing, nausea & vomiting. BP dropped to 85/42 and 02 Sat dropped to 87% on 02 2L via NC before developing asystole. Per Nursing documentation, HR 99-205.
Per 2/3/25 Gen Surgery PN, "Now POD3 from robotic ventral hernia repair with mesh. Having pain control issues. Tongue swelling today likely allergy from either dilaudid or oxycodone."
Per 2/3/25 Rapid Response documentation, "Received second call from RN, pt c/o SOB. When I arrived pt was sitting on the side of the bed, she said she couldn't breath. Breath sounds present, no stridor. Placed on NRB mask. Unable to get B/P or 02 sat reading. Pt began vomiting liquid dark emesis. Pt unresponsive. No pulse."
We are specifically seeking a hospital-based Pain Management physician from Florida (who also supervises mid-level providers) and who can speak on this case and speak for the actions of the mid-level ARNP, who was responsible for placing the original medication orders.
Attached you will find screenshots from the PM consult note for reference.
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