Idea Transcript
Running Head: THE LEWIS BLACKMAN STORY
The Lewis Blackman Story M3: Week 4: Paper Assignment Christina Jones University of Florida
1
THE LEWIS BLACKMAN STORY
2 Talking about Lewis
Helen Haskell starts her story by talking about her son, Lewis. She describes that he was a top student, a soccer player, a musician, an actor, and a natural comedian. He was athletic and healthy, and his parents felt like the luckiest parents in the world. They felt that he had a strong future ahead of him, but unfortunately, that future never happened. Ms. Haskell states that she always starts out by talking about Lewis because “This is about him. It’s about the patients who suffer because of the deficiencies in our system.” She describes her son so that listeners can get a better understanding of who this young boy was. He is more than just a statistic. He is a real live person who was a victim of medical errors. Ketorolac Ms. Haskell feels that the drug Ketorolac is to blame for a lot of what happened. She states that even though this drug is widely used in hospitals across the country, it is not approved in most of Europe and is restricted in many other countries. According to Vallerand, Sanoski and Deglin (2013), Ketorolac is a nonsteroidal anti-inflammatory agent and non-opioid analgesic. Common side effects include headache and nausea. More serious side effects include GI bleeding, oliguria, and renal toxicity. The normal dosage for parental therapy for adults less than 65 years old is 30mg every six hours, not to exceed 120mg a day. For those greater than 65 years old, less than 50kg, or with renal impairment, the dosage is 15mg every six hours, not to exceed 60mg a day. A pediatric dosage is not listed because safety has not been established in pediatric patients, and it is not approved for use in pediatric patients. Lack of Urine Output
THE LEWIS BLACKMAN STORY
3
Lewis’ mother states that he had no urine output for 24 hours, and this is a very significant and alarming finding, especially for a patient who is being administered Ketorolac. This drug and its metabolites are excreted primarily by the kidneys, and the drug is contraindicated in those at risk for renal failure due to volume depletion. Ms. Haskell states that Lewis had not been receiving adequate fluids, and was very likely volume depleted after surgery. Apparently, the resident had been following the fluid protocol for an individual who was much younger and smaller than Lewis, so the amount of fluids was not adequate to meet his needs. Administration of the Ketorolac at an adult dosage further taxed his kidneys and likely resulted in renal failure, as evidence by his anuria. Undetectable Blood Pressure Health care providers spent over two hours scouring the hospital for blood pressure cuffs. They tried to take his blood pressure 12 times using seven different machines. They likely blamed his undetectable blood pressure on equipment failure. Since they were unable to get an accurate reading, they brushed it off as an inaccuracy instead of trying to determine what was actually going on. It is possible that the hospital staff used several automatic blood pressure machines instead of attempting a manual blood pressure cuff. Perhaps Lewis appeared to be doing fine, so even after getting a very low blood pressure reading, they dismissed it as being inaccurate because it did not seem plausible to them that his blood pressure could actually be so low. Weekend I do agree that it is very significant that Lewis’ crisis developed over the weekend. One of the biggest reasons is because there is very often a shortage of staff during the weekend. This
THE LEWIS BLACKMAN STORY
4
usually results nurses having to take care of more patients, and not being able to devote as much time to each patient. Nurses are spread too thin and cannot do their job properly with inadequate staffing ratios. In addition to less nurses, physicians are often not as readily available during the weekend. Even if they answer the phone, without a nurse who is effectively able to communicate what is going on to the physician, the situation may be dismissed as unimportant, or something that can wait until Monday morning to address. Septic Shock Lewis died from septic shock. According to Seckel (2011), it is diagnosed in more than 750,000 patients per year and its mortality rate can be as high as 50%. In septic shock, there is a systemic inflammatory response to an infection, which ultimately results in decreased tissue perfusion and impaired cellular metabolism. General signs/symptoms include fever or hypothermia, tachypnea, tachycardia, and altered mental status. Lab values may indicate leukocytosis or leukopenia ,as well as increased lactic acid. Hemodynamically, the patient will exhibit with arterial hypotension. In terms of organ dysfunction, the patient may have arterial hypoxemia, acute oliguria of less than 0.5mL/kg/hr for at least two hours (as was the case with Lewis), an increase in serum creatinine, coagulation abnormalities, GI bleed (also was the case with Lewis), thrombocytopenia, or hyperbilirubinemia. Appropriate interventions for septic shock involve aggressive fluid resuscitation and supplemental oxygenation or mechanical ventilation. Drug therapy involves antibiotics, as well as vasopressors and inotropes such as dopamine or dobutamine. It is also important to obtain blood cultures and monitor temperature and blood glucose levels. A patient in septic shock is very critically and acutely ill, so it is important to frequently monitor the patient frequently.
THE LEWIS BLACKMAN STORY
5 References
Seckel, M. A. (2011). Shock, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome. In S. L. Lewis, S. R. Dirksen, M. M. Heitkemper, L. Bucher & I. M. Camera (Eds.), Medical-surgical nursing: Assessment and management of clinical problems (8th ed., pp. 1723). St. Louis, MO: Elsevier Mosby.
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2013). Ketorolac. Davis's drug guide for nurses (13th ed., pp. 750). Philadelphia, PA: F. A. Davis Company.