Death of 37-year-old with gastroparesis d/t Type 1 DM.
Multiple missed opportunities to diagnose and treat sepsis.
On 2/04/24 to 2/08/24: Admission to Hospital #1. Gastroparesis, Type 1 DM. Nausea & vomiting.
From 2/13/24 to 2/16/24: Admission to Hospital #1 for intractable n/v from gastroparesis unresponsive to Zofran. UTI on Rocephin.
From 2/18/24 to 2/28/24 Admission to Hospital #1 and on 2/26/24 – G-tube (Peg tube) inserted by Dr. A.
Discharged 2 days later, 2/28/24.
On 3/08/24 to 3/18/24: Admission to Hospital #1 for three days of abdominal pain. Temp 102. HR 125. WBC 34.5. Hgb 6.8. Cr 1.5. CT showed necrotizing fasciitis. On 3/8/24 - Open debridement done by Dr. A. On 3/12/24 – Second surgical debridement/Abdominal Washout by Dr. H. Closure of partially dehisced fascia, wound VAC placement. Candida positive intraoperative cultures.
From 3/18/24 to 6/10/2024: Admitted to Hospital #2
On 4/5/24 - Code Blue Rapid Response. Found pulseless/bradycardic, unresponsive. Intubated.
On 4/24/24- Rapid response for hypoxemia and bradycardia. Hemodialysis. From 6/10/24 to 6/24/24: Kindred ARU Admission On 6/21/24: Last hemodialysis at ARU. On 6/22/24: blood cultures growing gram-positive cocci.
On 6/24/24 to 6/25/24: Admission to Hospital #1. Septic Shock. WBC at 14. Intubated. CT of the brain shows diffuse cerebral edema likely due to septic emboli. CODE BLUE x 4. On 6/25/24 – TEE shows vegetation of the aortic valve consistent with endocarditis. Pronounced. Final diagnoses: cardiac arrest, Septic shock, Acute hypoxic respiratory failure, Endocarditis, CVA d/t septic emboli, Anoxic brain injury.
Files:
Q: was the PEG tube ever removed?
A: —
Do you believe there might have been medical error?
Without full records it is a bit difficult but it appears there may have been a time window when she has signs of sepsis and treatment may have been delayed. Also she had multiple embolism, endocarditis so it would be important to know what time window this may have developed.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Without full records it is a bit difficult but it appears there may have been a time window when she has signs of sepsis and treatment may have been delayed. Also she had multiple embolism, endocarditis so it would be important to know what time window this may have developed
What makes you a good expert for this case?
I have been in practice for 25 years working in PMR in inpatient settings and am very familiar with complex diagnosis.
How often do you encounter cases similar to this one in your practice?
Unfortunately I see these types of cases often.
Do you believe there might have been medical error?
not enough information provided, but described admission and inpatient care, not outpatient follow up and care. Mostly codes and renal failure issues, not sure where the PMR fits other than hypoxic brain injury at the end.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
no error was described in the narrative
What makes you a good expert for this case?
outpatient pmr primarily; did a lot of training and inpatient work in the past; I do record reviews and IMEs quite frequently
How often do you encounter cases similar to this one in your practice?
I see a review like this about once a year
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