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Friday, 29 July 2011

2 Years Old Child Dies After Tonsillectomy

Posted on 04:34 by Unknown
In Wichita, Kansas, jury has begun deliberation regarding the death of a 2 years old boy in 2006 the day after tonsillectomy surgery. Read the story here.

Based on the limited information provided, the relevant facts I have gleaned from the story are as follows:

• Child was appropriately admitted to the hospital after surgery
• There is some question regarding what was going on with his oxygen levels and other vital signs during hospitalization
• Autopsy revealed pneumonia confined to a small part of one lung
• Hydrocodone was prescribed for pain
• Lack of accurate communication between nursing and the surgeon
• Unclear patient/family factors
• Child had history of breathing problems (probably asthma)

Overall, it seems that this child's death was the result of many errors that piled upon each other. Any single error certainly wouldn't have resulted in death.

Reading between the lines, I conjecture the following might have occurred, giving as much benefit of the doubt to all parties involved, though I may be totally wrong:

1) Tonsillectomy surgery was uneventful and routine.
2) During extubation, coughing may have occurred with some aspiration of secretions (extubation... cough, cough, cough... strong inhalation with secretions resulting in aspiration)
3) Child was admitted after surgery due to age.
4) Child was overly sedated with hydrocodone and as such, not able to easily cough up secretions. Rather, probably slept more often than not.
5) Vital signs were probably on the low normal side. If truly abnormal, something should have been done immediately (nebulizer treatments, a chest x-ray, etc).
6) Lungs were listened to and potentially clear on auscultation given pneumonia was localized to only a small part of one lung. This exam was probably performed only once or twice. Given the child was sleeping, nursing may have decided (family may also have requested) that he be left alone so he can sleep rather than be disturbed and examined which would have caused him to start crying.
7) Patient was recommended for discharge the next day based on available information.
8) At home, child still overly sedated given hydrocodone administration by parents to treat pain resulting in inadequate lung ventilation thereby not allowing for aspirated secretions to be coughed up and out.
9) Death

A few areas of concern on my part...

It is possible in the parent's misguided resolve to ensure their child will not be in pain, that they may have given hydrocodone even if the child was not complaining of pain. It would be important to know what his hydrocodone narcotic level was in his bloodstream. In any event, this only reiterates that hydrocodone should not have been prescribed in a child this age. Rather plain tylenol or at most tylenol with codiene would have been more appropriate and certainly less sedating.

The story also reported the child had a history of breathing problems, most likely asthma. This fact just exacerbated the overall situation. In a healthy child, the lungs would have been much hardier and less prone to compromise.

Second, a pneumonia that has been present for many days is unlikely if localized to only a small part of one lung (one would expect a large area to be affected). Furthermore, if the pneumonia was as severe as they say BEFORE surgery, high fevers would have been present in which case, surgery would have been cancelled regardless of cause due to concern for febrile seizures induced by anesthesia.

In summary, what likely happened was an unrecognized aspiration event in a child with a history of asthma followed by over-sedation with narcotics which led to this unfortunate demise.

But... that's just my guess based on incomplete information.

Read the story here.

ADDENDUM 7/30/11: Jury ruled in favor of the defendants absolving of any malpractice in this case. Of note, a comment about the case by one of the jurors stated "I was one of the jurors on this case, and it was very hard to come up with a verdict. The reality of the situation is that there was not an acceptable cause of death and there was not enough evidence proving that Wesley and Dr. Kubina more likely than not caused the death."

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  • police
  • policy
  • pollen
  • polly hunsberger
  • polonium
  • polyp
  • pons
  • poor
  • popping
  • popular
  • popularity
  • portable
  • portman
  • positive
  • post
  • post-nasal
  • post-nasal drainage
  • posterior
  • pouch
  • power
  • ppo
  • practice
  • predicting
  • prediction
  • prednisone
  • pregnancy
  • pregnant
  • premarin
  • prenatal
  • prescribing
  • prescription
  • prescriptions
  • pressure
  • prick
  • prilosec
  • primer
  • problem
  • problems
  • procedure
  • process
  • professional
  • propel
  • protein kinase
  • provider
  • public
  • publication
  • puck
  • pulsatile
  • pumpkin
  • punishment
  • purchase
  • purulent
  • pus
  • puzzle
  • pylori
  • quickly
  • quickmark
  • r. kelly
  • radiation
  • radio
  • radioactive
  • radioactivity
  • radiological
  • radiology
  • raft
  • ragweed
  • random
  • rapid
  • raspy
  • RAST
  • reaction
  • reader
  • real-time
  • rebound
  • reckitt
  • record
  • recording
  • records
  • recurrent
  • red eyes
  • reduction
  • referral
  • reflux
  • regurgitation
  • rehm
  • removal
  • renovation
  • renovations
  • repair
  • repellant
  • replacement
  • reporter
  • research
  • residency
  • resident
  • resistance
  • response
  • resurface
  • resurfacing
  • review
  • rhinitis
  • rhinoplasty
  • richmond
  • right
  • ringing
  • rinse
  • risk
  • robert
  • robot
  • robotic
  • rock
  • roger
  • roof
  • room
  • rotating
  • routine
  • rubber
  • runny nose
  • rupture
  • ryan
  • safe
  • sale
  • saline
  • saliva
  • salivary stone
  • saltwater
  • santa claus
  • scan
  • scans
  • scar
  • scheduling
  • science
  • scientist
  • SCIT
  • scopolamine
  • scramble
  • scratch
  • screening
  • SD
  • seafood
  • search
  • seasonal
  • seaweed
  • secondhand
  • secure
  • security
  • sedated
  • sedation
  • self-pay
  • sensory
  • sepsis
  • septal
  • septo
  • septoplasty
  • septum
  • sermo
  • service
  • set
  • severe
  • sex
  • shampoo
  • shape
  • shark
  • shenandoah university
  • shop
  • shortness of breath
  • shot
  • shots
  • show
  • shrimp
  • sialadenitis
  • sialendoscopy
  • sialoadenitis
  • sickness
  • side
  • side effect
  • silent
  • silver nitrate
  • singer
  • singing
  • singing cat
  • singulair
  • singultus
  • sinuneb
  • sinuplasty
  • sinus
  • sinus fracture
  • sinus infection
  • sinus lift
  • sinus surgery
  • sinusitis
  • skating
  • skin
  • skin cancer
  • skull
  • sleep
  • sleep disorder
  • SLIT
  • sluder
  • small
  • smartphone
  • smell
  • smoke
  • smoking
  • sms
  • sneeze
  • sneezing
  • snore
  • snoring
  • snot
  • snotty nose
  • social
  • social media
  • social networking
  • soda
  • sodium
  • soft
  • song
  • sore
  • sore throat
  • sour
  • spa
  • spam
  • spanish
  • spasmodic
  • spasmodic dypshonia
  • spasmodic dysphonia
  • spasms
  • special
  • specialist
  • speech
  • speech therapy
  • spinal
  • spinning
  • spit
  • splints
  • split tube
  • spray
  • spur
  • ssnhl
  • staph
  • starvation
  • stat
  • station
  • stem
  • stereoisomer
  • sterile
  • steroid
  • steroids
  • sticky
  • stink
  • stone
  • stones
  • stops
  • storybooks
  • strange
  • strep
  • strep throat
  • stridor
  • strobe
  • stroboscopy
  • stroke
  • stuck
  • stud
  • student
  • study
  • stuffed animals
  • stuttering
  • sublingual
  • submandibular
  • submaxillary
  • sudden
  • sudden hearing loss
  • sun
  • sunblock
  • sunscreen
  • sunshine
  • superbill
  • superbowl
  • superbug
  • support
  • surgeon
  • surgery
  • surgical
  • survey
  • suture
  • swallow
  • swallowing
  • swelling
  • sword
  • symbicort
  • symphony
  • symptom
  • symptoms
  • syndrome
  • T-tube
  • tablet
  • talk
  • talking
  • tall
  • target
  • taste
  • tea
  • teacher
  • technology
  • teen
  • teenager
  • teeth
  • television
  • temperature
  • terrorism
  • terrorist
  • test
  • testing
  • tests
  • text messaging
  • the doctors
  • the onion
  • theory
  • therapy
  • thick
  • throat
  • throat cancer
  • throat clearing
  • throat-clearing
  • thrombosis
  • thrombus
  • throwing
  • thyroid
  • thyroidectomy
  • tia
  • tic
  • tic cough
  • tick
  • tilt
  • time
  • times
  • tinnitus
  • tiny
  • Tionne
  • TLC
  • TMJ
  • tobacco
  • TOCPM
  • today
  • tongue
  • tonsil
  • tonsil stones
  • tonsillectomy
  • tonsilliits
  • tonsillitis
  • tonsilloliths
  • tonsillotomy
  • tonsilolith
  • tonsiloliths
  • tony
  • tooth
  • tooth pain
  • top
  • topical
  • TORD
  • torres
  • tors
  • torticollis
  • tour
  • toxin
  • toyota
  • trach
  • tracheostomy
  • training
  • trans
  • translation
  • transmedics
  • transmission
  • transplant
  • transplantation
  • transportation
  • trauma
  • treating
  • treatment
  • tremor
  • trend
  • triangle
  • trombone
  • trouble
  • tube
  • tubes
  • tucci
  • tumor
  • turbinate coblation
  • turbinate hypertrophy
  • turbinate reduction
  • turning
  • tutorial
  • TV
  • tween
  • tweet
  • twitching
  • twitter
  • two
  • tylenol
  • tympanic
  • type
  • ulcer
  • ulpa
  • ulrich
  • ultrasound
  • unable
  • unclog
  • under
  • uninsured
  • united kingdom
  • university
  • Update
  • upper
  • upper respiratory infection
  • uppp
  • urgent
  • URI
  • urine
  • urticaria
  • usa
  • USA today
  • uva
  • uvula
  • uvulectomy
  • uvulopalatopharyngoplasty
  • vaccination
  • vaccine
  • vagal neuropathy
  • vascular
  • vasomotor
  • vasomotor rhinnitis
  • vcd
  • ventilation
  • versus
  • vertigo
  • ves
  • vessel
  • viagra
  • vibration
  • video
  • viral
  • virginia
  • virus
  • viruses
  • vit d
  • vitamin
  • vitamin A
  • vitamin d
  • vivosonic
  • vlog
  • vocal
  • vocal cord
  • vocal cord dysfunction
  • vocal cord paralysis
  • vocal cord paresis
  • vocal cords
  • vocal process
  • voice
  • voice therapy
  • voicebox
  • voicelift
  • volume
  • vomit
  • vs
  • wait
  • waiting
  • wall
  • wall street journal
  • warm
  • warrenton
  • washes
  • washington
  • washington dc
  • washington post
  • water
  • watkins
  • wax
  • wearable
  • web
  • web 2.0
  • webapp
  • Website
  • Website Update
  • wedge
  • weight gain
  • whale
  • what to do
  • wheezing
  • where
  • whisperer
  • whispering
  • white
  • who
  • whooping
  • wierd
  • wifi
  • will.i.am
  • wind
  • windows 7
  • winter
  • wire
  • wireless
  • withdrawal
  • without
  • woman
  • word
  • world
  • world voice day
  • world's
  • worlds
  • wound center
  • wp
  • wrestling
  • wrong
  • wsj
  • x-ray
  • xeomin
  • xray
  • xylitol
  • xyzal
  • youtube
  • zenker's
  • zenkers
  • zeta
  • zicam
  • zinc
  • zyrtec

Blog Archive

  • ▼  2011 (190)
    • ►  September (26)
    • ►  August (22)
    • ▼  July (20)
      • Tall Women (Over 5'1") Have Higher Risk of Cancer!
      • Tonsillectomy Airway Fire
      • World's Largest Tonsils Set in Guinness Book of Wo...
      • Novel Treatment for Non-Allergic Rhinits
      • 2 Years Old Child Dies After Tonsillectomy
      • Can a Deviated Septum Cause Facial Pain?
      • Awake Endotracheal Intubation Video
      • Test That Distinguishes Between Bacterial or Viral...
      • Snore Absorption Hotel Rooms
      • New Webpage on Peritonsillar Abscess Added to Website
      • R&B Singer R. Kelly Undergoes Peritonsillar Absces...
      • Robotic Mouth Sings the "Natural" Way
      • Video Made by Dr. Chang Shown on Animal Planet
      • Nebulizer Treatment for Chronic Sinusitis
      • Dr. Chang Quoted in National Press Release
      • New Video on Esophageal Manometry and 24 Hour Mult...
      • New Webpage on Bilateral Vocal Cord Paralysis (or ...
      • "Sneeze Whisperer" Target Pharmacy Commercial
      • Our Practice Website Completely Renovated (www.Fau...
      • Sermo iPhone App Review
    • ►  June (15)
    • ►  May (10)
    • ►  April (18)
    • ►  March (12)
    • ►  February (33)
    • ►  January (34)
  • ►  2010 (267)
    • ►  December (23)
    • ►  November (18)
    • ►  October (32)
    • ►  September (30)
    • ►  August (35)
    • ►  July (16)
    • ►  June (27)
    • ►  May (22)
    • ►  April (27)
    • ►  March (11)
    • ►  February (13)
    • ►  January (13)
  • ►  2009 (43)
    • ►  December (11)
    • ►  November (13)
    • ►  October (19)
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