Sudden death after pre-med

Re: Sudden death after pre-med

Hannah Wynne Richards — Sat, 26 Apr 2014 10:58:52 GMT

PS I always thought that was the reason medical (and veterinary ) students used to need compulsory O Level Latin

Wynne

Re: Sudden death after pre-med

Hannah Wynne Richards — Sat, 26 Apr 2014 10:55:03 GMT

Mark Can't you improve on" probable arthritis"? What about "femoro-tibial dolor?"

Re: Sudden death after pre-med

Anthony Dennison — Sat, 26 Apr 2014 00:33:29 GMT

[quote user="bob lehner"]I did manage to give a cat a dose of horse ACP once (the bottles are superficially rather similar). It slept for a long time - but fortunately survived.[/quote]

When I first graduated I gave a couple of dogs (including a young puppy) i/v phenobarb without diluting it 1 in 10 as per instructions on the vial. They slept a long time and were fine after!

Re: Sudden death after pre-med

Mark Holmes — Fri, 25 Apr 2014 20:34:19 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]Diagnosed? [/quote]

Yes doctors can always get away with a name, usually descriptive, which satisfies the patient but, as you say isn't a diagnosis.

I remember one of my nurses going to the local GP with excruciating abdominal pain.

A witty colleague said "she was told she had "dysmenorrhoea", I thought that was a symptom, but apparently it's a diagnosis"....

[/quote] Yes I have done/do the odd bit of standup comedy and I have a bit I have tried (needs some work) on Doctors simply repeating what you told them. Hence a complaint of sore skin becomes dermatitis which roughly translates as the same thing. A sore knee becomes "probably arthritis" which is actually less specific than the complaint and a diagnosis of alopecia tells you nothing more than a mirror would ( ie you have no hair). Hence doctors have the easiest job in the world.

Re: Sudden death after pre-med

bob lehner — Fri, 25 Apr 2014 17:44:17 GMT

[quote user="John Flynn"]As a student, I remember at least 2 incidents where I gave the wrong drug or dose as premeds and was fortunate that no fatalities resulted.[/quote]

I did manage to give a cat a dose of horse ACP once (the bottles are superficially rather similar). It slept for a long time - but fortunately survived.

Re: Sudden death after pre-med

bob lehner — Fri, 25 Apr 2014 17:41:36 GMT

[quote user="Malcolm Ness"]One of the basic requirements of a sucessful medic is the ability to bullish-t confidently in latin or greek.[/quote]

Indeed, as my barking mad old Latin master used to say quite often - 'Excrementia bovis sapientiam vincit' ( I may have got some of the endings wrong - it was a long time ago).

Re: Sudden death after pre-med

Malcolm Ness — Thu, 24 Apr 2014 21:32:53 GMT

One of the basic requirements of a sucessful medic is the ability to bullish-t confidently in latin or greek.

Re: Sudden death after pre-med

Anthony Todd — Thu, 24 Apr 2014 20:49:09 GMT

[quote user="Evelyn Barbour-Hill"]Diagnosed? [/quote]

Yes doctors can always get away with a name, usually descriptive, which satisfies the patient but, as you say isn't a diagnosis.

I remember one of my nurses going to the local GP with excruciating abdominal pain.

A witty colleague said "she was told she had "dysmenorrhoea", I thought that was a symptom, but apparently it's a diagnosis"....

Re: Sudden death after pre-med

Miriam Lodewyks — Thu, 24 Apr 2014 20:44:28 GMT

For what it's worth: our practice protocol is identical. Nurses admit and pre-med, unless an animal has not been seen by a vet in a while. If I could admit and check every single animal on the morning of the procedure, I would, but I'd have little time left for the other consults, so it's just not feasible. In the case you mentioned I'd hazard a guess that even a very thorough pre-op check would have shown nothing abnormal. Deepest sympathies to you and your client.

Re: Sudden death after pre-med

Evelyn Barbour-Hill — Thu, 24 Apr 2014 19:05:55 GMT

[quote user="Anthony Todd"]In 4% of sudden deaths in the 16-64 age group, postmortem examination fails to identify a cause; these cases are diagnosed as having sudden arrhythmic death syndrome (SADS).^[3]^[9][/quote]

Diagnosed? Hardly. "We don't know why you died. That's a disease we doctors call SADS"

Re: Sudden death after pre-med

Anthony Todd — Thu, 24 Apr 2014 17:58:38 GMT

This may help:

In 4% of sudden deaths in the 16-64 age group, postmortem examination fails to identify a cause; these cases are diagnosed as having sudden arrhythmic death syndrome (SADS).^[3]^[9]

The incidence of SCD is approximately 1 in 1,000 per year.^{[3] [Sudden Cardiac Death]}

From

http://www.patient.co.uk/doctor/sudden-cardiac-death-in-young-people

The irony for me is that one often anaesthetised very ill animals with massive murmurs etc. and they sailed through the GA, though I suppose they're getting pure oxygen and no cardiac load.....

Re: Sudden death after pre-med

John Flynn — Thu, 24 Apr 2014 04:14:58 GMT

As a vet, I have had one dog die after I gave acp/buprenorphine; it had a seemingly random pneumothorax.

As a student, I remember at least 2 incidents where I gave the wrong drug or dose as premeds and was fortunate that no fatalities resulted.

Some anaesthetic deaths are preventable (in each case of an anaesthetic death that I've personally witnessed I can think of things that could have been done better), some anaesthetic deaths are not-preventable - I consider yours to be one of these as I do not think any part of your approach was lacking in appropriate care. It's probably little consolation, and I appreciate it might actually be easier if there is something that can be identified or blamed and changed so that won't happen again, but I can't see anything that you could have done differently that would have affected the outcome.

Re: Sudden death after pre-med

Emily Nightingale — Wed, 23 Apr 2014 22:19:20 GMT

Dear Suzanne,

My sympathies.. How truly awful for you. I hope you are feeling a bit better a week hence.. Just to add to what others have said, the owner will have signed a consent form, which will have the wording "I give consent to my dog +++++ being given an anaesthetic, and understand there are risks involved with this" or words to that effect... The premed is part of the anaesthetic protocol for that patient .. and unfortunately you patient was the 1 out of the average 71 non elective patients that die as a result of anaesthetic protocol. For elective procedures its about 1/1200 ( I got these figures from a Anaesthesia and Analgesia lecture in 2010 held by VetsNow) So sadly your patient was that 1 /72.

All the best.. and many sympathetic virtual hugs your way!

Re: Sudden death after pre-med

Martin Atkinson — Wed, 16 Apr 2014 10:59:14 GMT

If all you say is a true account of what happened it is not your fault. Shit happens, it happens to us all. This is a real test of your coping abilities, you feel sorry for the pet and the owner but do not feel sorry for yourself, reproach yourself or engage in self-recrimination. Despite the fact we know that it is not our fault we feel bad about these things and owners naturally may think that you did something wrong but do not be swayed by that. Pour yourself a large measure of your favourite tipple, go for a jog or a bike ride or whatever you do to relax and move on its the only way. Tomorrow is another day.

Re: Sudden death after pre-med

Hannah Wynne Richards — Wed, 16 Apr 2014 10:22:30 GMT

For anything that isn't brachycephalic, you chose what I would think is the safest, most commonly used pre-med of the lot. You feel rotten at the moment - the fact that you do feel like that means you're a good caring veterinary surgeon.

To say it was "one of those things" sounds dismissive - it really isn't meant to be dismissive - it's the absolute truth. Absolutely awful for everybody.

Wynne

Re: Sudden death after pre-med

Andrew Kent — Wed, 16 Apr 2014 09:40:20 GMT

Hi Suzanne,

These really are horrible situations to be in and you have my sympathies as well. Even for us, with the luxury of specialist anaesthetists, these things still happen from time to time. Usually when it is that rapid then we guess it is either thromboembolic disease or an acute onset fatal arrhythmia, both of which could have virtually no clinical signs in advance. Unfortunately they are also difficult to demonstrate post mortem and so you may find your results are frustratingly vague.

It is difficult to know if you would have identified anything if you had examined the dog more thoroughly that morning, probably not I would think.

Andy

Re: Sudden death after pre-med

Bob Russell — Wed, 16 Apr 2014 09:34:11 GMT

My sympathies as well. I lost a bitch spay three days post-op earlier in the year. First one ever! It was devastating for everyone in the practice and we spent a lot of time with what ifs? A really aggressive infection according to the specialist that did the post-mortem. We reviewed everything but really did not find a reason.

No harm in having a chat with VDS. They are very comforting and good at guiding the sympathy letters!

I would consider the ACP/bup combination to be extremely safe and has been used a million times uneventfully. Perhaps this was just one of those idiosyncratic reactions that you only discover when it is too late!

Rotten thing to happen but it just does!

Re: Sudden death after pre-med

KMurphy — Wed, 16 Apr 2014 09:18:17 GMT

Nothing to offer, I'm afraid, except great sympathy for you. Sometimes these things just happen; I know that doesn't mean much when it's just happened to you but it really isn't your fault.

I hope you're doing okay today xx

Re: Sudden death after pre-med

Hannah Wynne Richards — Wed, 16 Apr 2014 08:55:36 GMT

You didn't do anything wrong, so it's not your fault..............terribly upsetting for everybody. My sympathiy

Wynne

Re: Sudden death after pre-med

CatherineThomas — Wed, 16 Apr 2014 07:43:43 GMT

That must have been awful for you. Working as a locum I've seen several different approaches to admitting and checking animals, some where vets admit and check every animal and some where nurses do it all and vets only check the odd ones who haven't been seen recently etc.

At one of the practices there was a dog who collapsed after the ACP/vetergesic pre-med, he wasn't my case but i think it was about 10-15 mins after it was given it was noticed that he was flat out in his kennel, unresponsive with a slow heart rate. Fortunately that dog did survive but it took a few hours of treatment and constant monitoring before he was fully ok. That was pretty scary. He was in for a routine castration. The vet had checked him out before his pre-med and hadn't noticed anything unusual. I know that a referral was arranged to try to investigate but I don't know what came of it.

Re: Sudden death after pre-med

Camilla Edwards — Wed, 16 Apr 2014 04:49:35 GMT

Hi Suzanne, I'm so sorry that this happened. I've not had a case die after acp/vet premed so I too would be in shock. It sounds like you do a very thorough job and I too if checked recently wouldn't have rechecked either. Although some cases are good to learn from its important to do it in an objective way. The last case I had which went wrong was a cat who received an overdose of metronidazole due to a miscommunication about iv and oral doses (fortunately the cat was fine). Once I finished beating myself up (which it sounds lke you're at that stage!) I tried to do an objective chart of the stages that happened (I think there's an official term - adverse event something?) to see if there was anything we could do differently. It helped me to look at it objectively and systematically and enact a change which made it into a more positive event.

But unfortunately not everything in our line of work is predictable or preventable - these things will happen. I hope you had an ok nights sleep and feel better today.