Post on 12-Nov-2014
description
Title Page
Title
MEDIATION
MEDIATIONMarch 3, 2008
James Rasnake,
vs
Grand Strand Regional Medical Center, LLC
1
COMPARTMENT SYNDROME
A condition in which increased pressure within a limited space compromises the circulation and function of the tissues
within that space.
RAMPANT – UNCONTROLLED SWELLING
2
Mechanism of InjuryCOMPARTMENT SYNDROME
Aortic ValveReplacement(mechanical)
FRIDAYDec 2, 2005
Triple bypassmammary & saphenous vein
grafts
ICU
increased outputsurgical drain
Re-explored
ICU 3
Mechanism of InjuryCOMPARTMENT SYNDROME
Post OperativeEdema
24 hours
SATURDAYDecember 3, 2005
PCU
Abnormal buildupof fluids that
leads to
SWELLING
Responded to
Diuresis
4
SymptomsCOMPARTMENT SYNDROME
SYMPTOMS
Non-specific aching of the hand
Disproportionate pain
Loss of digital motion
Continued swelling
High Alert for Signsand
Symptoms 5
Mechanism of InjuryCOMPARTMENT SYNDROME
Increased painand
swelling in right armand hand
SUNDAYDecember 4, 2005
PCU
Doctor notnotified
Mr. Rasnakeconscious andcomplaining
6
Pain out of proportion to injury
Palpable tense compartment
Pain with passive stretch
Parethesia
Pallor
DiagnosisCOMPARTMENT SYNDROME
DIAGNOSIS
7
Mechanism of InjuryCOMPARTMENT SYNDROME
Increased pain andswelling in right arm
and hand with Parethesia
MONDAYDecember 5, 2005
PCU
DIAGNOSIS:Compartment
Syndrome
Swelling increased overright arm and hand over
past two days
Thomas J. Chambers, MDConsult
8
DutyGRAND STRAND MEDICAL CENTER
MONDAYDecember 5, 2005
“This appears to be most likely a
reperfusion injury.”
Thomas J. Chambers, MDConsult
Fasciotomy12/05/05
9
COMPARTMENT SYNDROME
December 2005
Mon Tues Wed Thurs Fri1 2 3
4 5 6 7 8 9
BypassICU
ICUPCU
Swelling
Swelling
PAIN
SURGERY Disch
arge
d 10
11 12 13 14 15 16 17
18 19 20 21 22 23 24
25 26 27 28 29 30 31
Weekend
Doctor not notified ofincreased pain and
swelling in handand
forearm
SatSun
PAINSwelling
10
Mechanism of InjuryCOMPARTMENT SYNDROME
Bone
Nerves
Veins
Arteries
11
COMPARTMENT SYNDROME
Pressure – No Outlet – Blocked by Fascia
Tissue, Nerves &
Veins Compressed
Damaged or Dead
Mechanism of Injury
12
Fascia
Damage & DeathCOMPARTMENT SYNDROME
Tissue Survival
3-4 hours – reversible changes6 hours – variable damage8 hours – irreversible changes
Muscle
Nerve2 hours – looses nerve conduction4 hours – neuropraxia8 hours – irreversible changes
13
TreatmentCOMPARTMENT SYNDROME
FASCIOTOMY
Incision through skin & fascia to release pressure
14
Treatment
Tissue, Nerves & Veins Decompressed
COMPARTMENT SYNDROME
15
Fascia
Thenar Muscles – Thumb Dexterity
Right HandFASCIOTOMY
16
Median Nerve
ThenarMuscle
Right HandFASCIOTOMY
17
Dorsal Interrosei Muscles - Grip
Right HandFASCIOTOMY
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Right ArmFASCIOTOMY
ForearmExtensor
Compartment
Grip
19
DutyGRAND STRAND MEDICAL CENTER
Patient’s Rights
Pain Management
Pain relief measures
A concerned staff committed to painprevention and pain management
Health professionals who respond quickly to reports of pain
Your reports of pain will be believed
State-of-the-art pain management20
DutyGRAND STRAND MEDICAL CENTER
Policies & ProceduresUnconscious exam Examine in orderly, symmetrical fashion (Ensures all areas are assessed; compare one side to the other so abnormalities are more easily identified.)
Do a brief exam at shift change Page 37
Critical care patients with change in condition Page 58
POLICY: The physician will be notified Immediately of any significant deterioration in the patient’s condition.
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DutyGRAND STRAND MEDICAL CENTER
WednesdayDecember 8, 2005
Noon
22
FamilyJAMES RASNAKE
23
Grip & Fine MotorJAMES RASNAKE
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Grip & Fine MotorJAMES RASNAKE
25
DAMAGES SUMMARY
26
DAMAGES SUMMARY
Medical Expenses $ 63,663
Pain & Suffering Past and current 7-10 on scale of
10 at end of work week
$ 200,000
Nature, Extent & Duration of injury Permanent disability & disfigurement
$ 250,000
TOTAL DAMAGES: $ 1,211,127
Lost Wages and benefits 14 years remaining work life
$ 707,464
MEDIATION: $960,000
END
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END