A 17-year old dies after a tonsillectomy:
Irene Triplett’s lawyer, Bruce Fagel, said that Lee ordered the nurses to give Versed, a sedative, to calm Gomez before surgery. At the post-anesthesia care unit, Gomez was given two injections of two milligrams of morphine. The injections were 10 minutes apart, Fagel said. The morphine was given because a nurse thought Gomez was in pain because he was “moaning.” Those drugs caused him to stop breathing, Fagel contends.Defense attorneys are denying their clients were responsible. Experts testified about the effects of drugs and how they might have affected Gomez’s medical condition, obstructive sleep apnea. Also, the surgery was complicated because he had a large tongue, small airway and large tonsils, characteristics of Down syndrome. They also have pointed out to jurors that Gomez was 4 feet 10 inches tall and was overweight at 176 pounds.
2mg of morphine 10 minutes apart should not lead to respiratory failure.
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Cathy,
While not about the article, I wanted to comment on the morphine. It’s not just for chronic terminal pain. It can also be used in extended release for chronic, severe, non-cancer pain. I’d share more insight on that topic, but I can’t. Suffice it to say that for some people, it can be a lifesaver…
And the other thing is that many patients won’t ever remember the pain meds they receive in the immediate post-op period in recovery. You’d know if you received morphine once you were back in your own hospital room or ambulatory care center, and at that point, you’re right, it probably wouldn’t be offered in most cases for tonsillectomy. However, in the OR recovery period, they often still give IV pain meds to treat pain at that phase. The patient isn’t even awake enough to take a med by mouth or have any water, etc at this point. I don’t think morphine for the immediate post-op pain is out of the question. There are lots more stronger pain meds out there…
Take care,
Carrie
It’s not that I’m afraid of morphine, I just don’t like taking it. I had a big surgery last year and was on a morphine pump. BTW, I’m a grown woman and this was major surgery. My pump was set at 1mg every 10 minutes is what I could get. I couldn’t stand the itching and asked for it to be taken off the next day and to give me oral darvocet.
As for dilaudid, I have received it once, in the ER after an accident. Holy cow, she was still putting it in my IV and it felt like I was being put under for surgery. My GI doc uses fentanyl for EGDs that I have every 6 months. He used to use demerol but now he uses that, I have no idea why. When he used the demerol with the versed I had no after effects. I would come home and feel good. Wasn’t sleepy at all. With the fentanyl I’m a zombie for the entire day. Just come home and sit and sleep. I hate it also.
Admittedly there are many things about medications I don’t know. I’m not a Dr. But,I wonder about an adult woman receiving 1mg morphine every 10 minutes for a very painful surgery recovery vs a child being given 2mg at 10 minute intervals for having his tonsils removed. I’m not placing any blame any where just making an observation.
Carrie, Thanks for your explanations…:)
Since I am one of the most hated commentator’s on Kevin-MD – you might as well pile on after these comments.
Fixed agents are a ‘no-no’ with patients who have a propensity towards developing airway obstruction. Versed and valium were probably not good choices-but lets put that aside.
Morphine is not a fixed agent. 2mg. times two doesn’t equal a ‘narcotic death.’
Having said this-when a patient is thrashing about it usually raises the possibility [ duh! ] that the patient is anoxic and scared to death that he can’t move air across the glottic aperture. You know-like, I can’t breathe!!
Extubating this patient was probably not the best idea-but I wasn’t there, so who am I to criticize.
Gee!! Let me say it one more time—extubating this patient was not a good idea–apparently. Was there some rush to get him home? !!!
Is this some mystery case?!!!
Dr. Mangino, off topic..Do you have a BLOG of your own? I tried to find you on one but no luck yet. Was just wondering.
Well, thank you for asking, Cathy. You must be the only person in America who wants to read my blogs-comments! Even my mother has never asked!!
No I don’t- I read Kevin once in awhile. I have written extensively on the subjects to which I limit my comments; pain management, anesthesia and some civil rights and constitutional issues-like the governments’ war on pain specialists who prescribe opioids. I happen to be one of them.
While my comments may seem overly critical of others-the fact remains that my rhetorical questions are meant for everyone-me included.
This case [ above ] in question, is sad for the child and family-and for the doctors. While I believe in what I say, the fact is, we don’t know how these situations develop if we are not there.
If you are interested in this particular case then read a standard pediatric anesthesia text on airway management for a child that has to return to the OR with re-bleeding.[ full stomach or not ].Also on the management of epiglottitis-which gives similar types of info.
Obese kids with airway obstruction are tough to manage. As a former ENT resident and anesthesiologist I faced similar situations.
Just because there may be malpractice in this world-doesn’t mean that a lawsuit will resolve it.
If the lawyers want us to be ‘Marcus Welby’ then lets have them start acting like ‘Atticus Finch.’
Best wishes to you – and to other readers. I’m the last guy in the world that needs a blogsite.
Cathy,
No there is no blogsite for me; much to the delite of most readers.
Take care.
I don’t know why you believe you are the last person who should have a blog? There are no qualifications too meet. Anyone can (and does) have one. I think you have alot to say and that people could learn from reading what you write. I find you interesting.
Who cares whether people agrees with you or not. A blog is about saying and writing what you believe in. It’s also a great stress reliever and a way to get rid of frustrations. Many come and read and never return, (most in my case), but some stick around and you can have some pretty good back and forths. You already know that.
Being chronically pissed off on a BLOG, keeps me from being that way with my family and friends.
Anyway, I just wanted to tell you that I think you could have a really good BLOG if you tried it.
Dr. Maningo,
I’ve read several of your comments on this site, and I have agreed with a lot of what you said! Plus, I think we have place of employment in common – one of your formers is my current, if I remember correctly!
Don’t be so hard on yourself – your writing is very thought-provoking.
Take care!
Carrie
Dear Cathy and NeoNurse Chic-appreciate your kind comments.
I hope your current place of employment is not that small hospital in Illinois – where they escorted me to the door when I criticized the surgeon for instructing the nurse anesthetist to “Keep the patient light,” [referring to the level of anesthesia ] which resulted in an aspiration pneumonitis that could have been avoided had my instructions been followed [ by both the surgeon and his “buddy” the CRNA.
I suggest to anyone who works in an OR, where I’ve been, to not mention my name- if you value your political longevity.
By the way-I was never sued-they were-they lost – and now, when I drive through Illinois I get a very good feeling.
Hell has no fury like that of a doctor scorned.
I live just outside Philadelphia…so no, it’s not Illinois.
And I’m not an OR nurse by any means…I’m a neonatal nurse.
Take care,
Carrie
It would appear that Dr. Mangino now HAS his own weblog (and fans, to boot) right here.
I don’t want fans or a website- believe me.
All of this is for naught in that the jury returned a verdict in favor of the defendants.
“Hell has no fury like that of a doctor scorned.”
I don’t know about that one. I’ve seen some pretty angry patients, especially those who are given inadequate pain management after surgery. Maybe the doctors just get more opportunity to express it. However, I think physicians are more likely to get their way, especially in a hospital setting (patient vs. doctor-who do you think is going to win? It would be nice if all such pairs could work together).
Also, pain is a subjective thing. Whether or not narcotics or whatever are appropriate after a surgical procedure depends on the severity of said procedure AND the patient’s reported pain. When we start to assign an amount of pain that someone “should” be feeling, we leave ourselves open to the distinct possibility of undermanaging pain. And such a possibility is a horrible reality to many, many patients today.
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