Page 49 - Part 1 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

CASE STUDY

continued
OR at the time of induction. The patient was intubated with

a Miller 3 blade with a #7 endotracheal tube but could
not be ventilated. The tube was removed and reinserted,

but the CRNA still could not ventilate the patient. The
tube was removed and bag valve mask ventilation was

attempted with minimal success. The patient’s oxygen
saturation fell to 88 percent. The anesthesiologist arrived

in the OR and determined a need for an emergency airway
and proceeded with a cricothyrotomy for oxygenation.

The patients O2 saturation came up to around 93 percent
with the insertion of the jet ventilator needle. However,

secondary to the jet ventilation, there was massive
subcutaneous emphysema. The anesthesiologist then

made an incision for an emergency tracheostomy. The
surgeon arrived and completed the procedure. There

were still problems with ventilation, so the surgeon placed
bilateral chest tubes. The patient began to stabilize and the

oxygen saturation increased to 100 percent. The patient was
then transferred to a tertiary hospital where she was treated

for ARDS (Adult Respiratory Distress Syndrome) bilateral
pneumonia, and a laryngeal fracture. She improved and

was discharged three and a half weeks later to home with
a tracheostomy and was on oxygen. She had permanent

injury to her vocal cords.

The plaintiff’s expert asserted that the anesthesiologist had
a duty to explain the potential problems and complications
to the patient and advise of potential alternatives to the

anesthesia plan that addressed the likelihood of a difficult

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