Cassie Guthrie: An Unexpected Death After Routine Surgery
Cassie Guthrie, Legal Nurse Consultant, shared on LinkedIn:
”An Unexpected Death: Less than 12 Hours after Hospital Discharge
A new mysterious case is now sitting on your desk for possible medical malpractice. You learn that the family was told it was a “routine” surgery and went according to plan. The patient even discharged home. You’re thinking, what actually happened?!?
It’s become apparent after the receipt of autopsy records that the indicated cause of death was a catastrophic intracranial hemorrhage (ICH) with brain herniation after a common femoral endarterectomy (CFE). These findings sound unfathomable…
This would be the opportune time to have a legal nurse consultant, like me, available to your team. I’m the medical equivalent to a private investigator. A real life sleuth. I find the medical record facts and provide the evidence based answers to these questions.
Intracranial hemorrhage or hemorrhagic stroke is rare after a peripheral vascular surgery. However, consideration of ICH during post-operative recovery is warranted.
The most likely mechanism of stroke after CFE typically originates from an embolic event. As an example, manipulation of devices and/or deployment of a stent that trigger an embolism from plaque fragments, blood clot or an air embolism can also travel to the cerebral circulation.
As noted above, less commonly, a hemorrhagic stroke can occur due to vessel perforation, dissection, or choice of anticoagulation therapy in vulnerable patients.
Key risk factors for hemorrhagic stroke:
- Pre-existing Cerebrovascular disease
- Arteriovenous Malformations
- Aneurysms
- Anticoagulant therapy in certain patients
- Hyper perfusion syndrome or reperfusion injury
Monitor efficacy of anticoagulant therapy with lab tests, assess for increased bleeding, trend cerebral perfusion pressures and signs of Cushings Triad (bradycardia, widened pulse pressures, irregular respirations).
A reperfusion injury is a complex phenomenon where the restoration of blood flow to previously ischemic tissues exacerbate cellular damage. This injury is mediated by a cascade of oxidative stress from sudden influx of oxygen, activation of inflammatory pathways, endothelial dysfunction, and calcium overload. Contribiting to further cellular necrosis and tissue damage. These conditions can lead to devastating and irreversible neurological deficits.
Post-procedure neurological assessment and early recognition of stroke:
Think F.A.S.T!
Face, Arm, Speech and Time
- Facial drooping
- Arm or extremity weakness
- Speech difficulties
- Time-sudden onset
Other signs: new headache, altered consciousness, paralysis, nausea and vomiting, seizures
Late symptom: inability to arouse, loss of consciousness
My fellow LNCs and MD experts – does an adverse event like this typically happen unexpectedly? What questions would you be looking for to determine if this case is meritorious for negligence? Comment your thoughts below.”
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