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Educational Articles

Delayed Intubation Alleged Cause of Death – Illinois Defense Verdict for Anesthesiologist After ED Physician Settles for $500,000

 

The decedent a fifty-two year old man presented to the emergency department at a hospital with neck swelling due to angioedema triggered by a reaction to an ACE inhibitor medication. The emergency department personnel treated the decedent. However, the decedent suddenly experienced an inability to breathe. The emergency department physician was unable to intubate the decedent. A code blue was called and anesthesia was paged immediately. After eleven minutes, the defendant on call anesthesiologist arrived at the emergency department. As a result, the decedent sustained a lack of oxygen to his brain, anoxic encephalopathy, and ultimately death. The defendant anesthesiologist contended that he was delayed because he did not have the necessary equipment ready in advance, so he had to go to the operating room first to retrieve the equipment. However, the operating room was locked and he then had to unlock several cabinets and relock them when he finished. The estate alleged that if the defendant had gone directly to the emergency room, he would have prevented the catastrophic brain damage that led to his death. The defense contended that it was reasonable for an anesthesiologist to obtain needed supplies before going to the emergency room. Furthermore, they contended that the emergency room physician was in charge of the patient’s care, and her actions were the sole proximate cause of the patient’s death. The emergency department physician settled for $500,000 prior to trail. The jury returned a defense verdict.

 

Expert and definitive airway management is fundamental to the practice of emergency medicine. Emergency departments should be well equipped for airway care and endotracheal intubation regardless of who performs the intubation. It is highly recommended that rescue devices like laryngeal mask airway, intubating laryngeal mask airway, video or fiber optic airway devices, and emergency cricothyroidotomy kits should be readily available as well as being prepared for the difficult airway.

You should develop standard equipment lists for both adult and pediatric supplies, a difficult airway kit that includes a cricothyroidotomy kit as well as a surgical tracheostomy tray. You should often review the supply list, the equipment, its location and its use.

In critically ill patients, rapid-sequence intubation (RSI) is often used to facilitate endotracheal intubation in order to minimize aspiration, airway trauma, and other complications of airway management. All staff should be very familiar with the agents and routine doses, trained in their uses and contraindications, and prepared to utilize RSI and monitor these patients once they are intubated and placed on a ventilator.