"Theatre nurse Mayra Cabrera, 37, suffered a heart attack after an epidural was fed into her arm instead of her spine." From the BBC article, Injection Death Hospital 'Sorry'.
Another case where I wonder since this can happen to a nurse who had worked at that hospital as recently as 2004, then what are my chances of surviving trips to the hospital? And aren't these needles different? If not, shouldn't they be color coded? Something?!
Yeah, this is a wierd one. I don't deal with epidurals in ER, but when I've had them pre-op, it's an anesthesiologist who does it and manages the meds to it.
The wrong drug must have gone in the wrong port....this is not my area of expertise, though. And I wonder if the drug in question had a "reversal agent".
No matter how you look at it,it is just tragic.....
Posted by: Kim | June 05, 2006 at 07:23 PM
Thanks CD, I was hoping we'd get your expertise on this one.
I cannot get over the mistakes that can be made in hospital (not to mention in the media coverage!). Very, very frightening.
Posted by: Gimpy Mumpy | May 31, 2006 at 05:09 PM
Oh, and she won't have suffered a "heart attack" (myocardial infarction); she will have suffered a cardiac arrest (heart stops beating). I do wish the media would learn to get that right.
Posted by: charlesdawson | May 31, 2006 at 03:04 PM
Now this is an interesting one. If the lady was having an epidural, the first thing they would do is set up a peripheral intravenous line into the arm, not just a buttefly cannula, presumably, but a venflon with an injection port. Normal saline in the infusion bag, probably. Then the anaesthetist would set up an epidural. That would sit there for the duration of the labour, as it would need periodic top-ups as the anaesthetic wore off. So there would probably be a short line running from the epidural site, with an extra filter in it, to a luer connection for a syringe to be attached with the top-up.
Sounds as if somebody either drew up the wrong drug or drew up the right drug but plugged it into the wrong connection. How that latter could happen, I don't know.
Posted by: charlesdawson | May 31, 2006 at 08:25 AM