13. Deaths and other problems related to medical care

Question 1

over 60% of deaths within medical care occur with …

Answer 1

surgery and procedures

Question 2

most deaths investigated by the legal authorities will come under one of these categories: (6)

Answer 2

1. during surgery
2. related to medical procedures
3. complications of medication
4. missed or delayed diagnoses
5. complaints about poor general care
6. accidents, suicides etc. within hospitals

Question 3

why do deaths occur during surgery?

Answer 3

usually because the person was already in poor health (obese, heart disease, diabetes)

reasons for dying:
1. dying from condition being treated
2. dying from co-existing disease
3. dying from the general risks of any surgery from just being in hospital
4. dying from complications due to general poor health and poor healing response

Question 4

deaths within medical care will usually be due to (3)

Answer 4

1. known risks
2. unexpected complications
3. substandard medical care

Question 5

substantial medical care 2 types of scenario

Answer 5

1. possible (e.g. an otherwise fit man getting septicemia after the repair of a fractured femur)
2. definite (e.g. needle left behind in the abdomen after aortic graft surgery, later puncturing the vena cava)

Question 6

what are some examples of problems airing from investigative procedures (4)?

Answer 6

1. perforation of the esophagus during esophagoscopy (the most common)
2. pancreatitis developing after ERCP
3. coronary artery dissection during angiography
4. hemorrhage from a biopsy site

Question 7

what are some examples of problems arising from Inserted tubes? (4)

Answer 7

1. urinary catheter puncturing the bladder
2. chest drain puncturing the lung
3. PEG tubes for direct gastric feeding leaking internally
4. tracheostomies blocking, dislodging, or causing bleeding

Question 8

recognized risk of drugs: warfarin/thrombolysis

Answer 8

spontanous subdural or intra-abdominal hemorrhage

Question 9

recognized risk of drugs: antipsychotic

Answer 9

ileus and bowel obstraction with clozapine

Question 10

recognized risk of drugs: antibiotics

Answer 10

pseudomembraneous colitis, toxic epidermal necrolysis

Question 11

recognized risk of drugs: analgesics

Answer 11

gastric hemorrhage with aspirin

Question 12

recognized risk of drugs: anaesthetic

Answer 12

hyperthermia, allergic response

Question 13

what are some prescribing and administration errors (3)

Answer 13

1. given the wrong drug
2. given the wrong amount
3. given the wrong way

Question 14

general hazards of general anesthesia (3)

Answer 14

1. equipment failure or malfunction
2. wrong gases used
3. patient sensitivity to particular anesthetic (e.g. halothane)

Question 15

general hazard of dental anaesthesia

Answer 15

being administered by a sole practitioner (.e. dentist and anesthetist) without available support if something goes wrong

Question 16

general hazards (2) of local anaesthesia

Answer 16

1. giving excess drug e.g. lignocaine producing serious vasoconstriction or provoking a cardiac arrythmia
2. introducing infection e.g. with epidurals

Question 17

what are some hospital acquired infections (2)

Answer 17

Staphylococcus aureus MRSA
Clostridium difficilie (C diff)

Question 18

describe MRSA (mention 5 points)

Answer 18

1. commonly found harmlessly on the skin
2. cause of wound infections, food poisoning
3. most infections treatable by antibiotics (vancomycin, TMP-SMX)
4. some strains are resistant (MRSA methicillin resistant S. aureus)

Question 19

Describe clostridium difficile infection (mention 5 points)

Answer 19

1. commonly occurs harmlessly in the bowel
2. causes problems when the normal bowel flora is disturbed by antibiotics
3. causes diarrhea which can range from mild illness to life threatening colitis
4. elderly most at risk
5. infection can be spread by health care workers

Question 20

what can poor nursing/general medical care lead to

Answer 20

development of bed sores, hospital acquired infections, poor nourishment