Talk about adding insult to injury. When someone is injured as a result of some type of trauma, such as a car accident or fall, the last thing they would imagine is having their injuries compounded by the negligence of medical professionals. In such instances, patients and family members may attribute the resulting injuries (or death) to the initial trauma rather than subsequent medical negligence — and (for obvious reasons) that is how the story is often told by doctors to family members.
As a word to the wise, below we discuss one such example (based on a real life case in another state) of medical malpractice following trauma:
A man is involved in a motor vehicle accident and taken to a local emergency room. The first rule of ER care is to diagnose and treat the most serious, immediate conditions before moving on to treat less serious conditions. Accordingly, when the man presents to the hospital with severed arteries and is experiencing an exsanguinating hemorrhage, the doctors are taught to stabilize the hemorrhage before moving on to diagnosing or treating a less serious injury, such as a possible meniscus tear in the patient’s knee.
The severed arteries is a life-threatening condition that likely requires emergency surgery. Therefore, an doctor’s decision to order a CT scan of the patient’s knee without controlling the arterial hemorrhage places the patient at risk for additional harm because the patient is already on the verge of cardiac arrest. The patient is likely to lose more blood wile waiting and undergoing the knee CT imaging study, causing unstable vital signs (blood pressure, heart rate, etc.).
Substantial blood loss causes the inability to adequately perfuse the tissues of the heart. When the blood does not circulate throughout the body, carrying oxygen, tissues die. As an example, after six minutes without oxygenated blood, nerve cells begin to die.
Without controlling the bleeding, the patient may continue to lose blood and suffer cardiac arrest while he in the CT scanner, causing irreversable damage from the lack of oxygen, such as paralysis or even death. The standard of care of a reasonably careful doctor under such circumstances should be to stabilize the hemorrhage before sending the patient to the CT scan. One of the maxims when caring for a patient with a traumatic injury is that an unstable patient should go to the operating room (OR) if the bleeding can’t be stabilized, and an unstable patient should never be sent for CT scanning.
Indeed, the American College of Surgeons has offered certification in Advanced Trauma Life Support for many years. This course usually takes four days for certification and it is offered only to physicians. The course is a requirement for many physicians who work in Emergency Departments. The ATLS course teaches physicians a systematic approach to dealing with any traumatic injury. The recommended modality of imaging in an unstable trauma victim is the portable ultrasound examination for injuries to the pelvis, abdomen, or pericardium. Other injuries that cause rapid blood loss are often seen, as in an open fracture with an arterial laceration.
If there is an obvious exsanguinating bleed, the first task in stabilizing the patient is to stop the bleeding. Internal bleeding that is causing hemodynamic instability, such as dangerously low blood pressure, should be taken to the operating room without further studies to pinpoint the location of the bleed. In the case of an open fracture of a limb, the site of the blood loss may be evident. Femur fractures are often the cause of rapid hemorrhage.
There are various ways to stop a serious bleed in an emergency. Arterial bleeding results in spurts of bright red blood, because the blood in the arteries carries oxygen throughout the body. Direct pressure helps stop some arterial bleeding. This causes arterial constriction. Putting pressure on the major artery that feeds the bleeding artery may be effective, and in an emergency, a paramedic may use some sort of tourniquet, which is only a temporizing measure. Tourniquets fail to stop major arterial bleeding when they are not tight enough to compress the arteries of a limb, and they may increase bleeding from retrograde venous blood flow. The use of tourniquets is controversial. In cases of smaller bleeds that won’t clot, there are hemostatic agents that can be applied externally to the wound, but this is not effective with major bleeding in patients without a clotting disorder.
In our example, the doctors and other medical professionals caused a catastrophic injury to a patient who was only moderately injured in the car accident. That is what can happen when doctors deviate from the generally accepted standard of care and violate a basic tenet of emergency room care.
If you or a loved one has a disability as a result of delayed control of bleeding for inappropriate imaging studies after trauma, consult a medical malpractice attorney at Passen Law Group at 312-527-4500 for evaluation of your case.