Doctors and Nurses Must Look for Signs of Problems and Prevent Harm to Patients

A doctor may rule out the most immediately life threatening condition, stabilize a patient, and reach a diagnosis and plan for a patient on day 1.  But, depending on the nature of their illness, a patient’s condition can change rapidly.  A patient who is stable on day 1 may deteriorate on day 2.  Doctors and nurses must remain alert for medical clues which raise a red flag for a patient on the verge of sudden deterioration or death.  Examples include:

  • X-rays reveal acute changes in the lungs or around the heart.  A chest x-ray shows air, blood, or fluid accumulating in the potential spaces in or around organs and structures of the chest or abdomen.   X-rays can help care providers diagnosis conditions like acute pneumonia or contamination in the spaces surrounding the small bowel or colon, often related to unintended injury to the intestines during the course of surgery or preexisting conditions such as colitis or diverticulitis.  X-rays of the abdomen and chest are often performed at the patient’s bedside on an emergency, a.k.a. STAT basis.
  • Caregivers must measure and remain aware of a patient’s blood pressure at regular intervals.  Sudden and persistent drops or elevations in blood pressure may be caused by a condition which, if not recognized and reversed, can lead to shock, organ damage and death. The duration and extent of hypertension or hypotension provide clues for the practitioner to combine with other vital signs, such as heart rate and temperature, blood tests (including hematocrit, hemoglobin, and white blood cell count), and other clinical criteria with the goal of diagnosing the underlying cause of the deranged blood pressures and securing appropriate treatment to bring the pressures back within the normal range.
  • Nurses and doctors must recognize and treat a patient whose urine output is inadequate and lagging compared to their intake of fluids.  Low urine output may be a sign of poor fluid intake alone, or the sign of a serious illness affecting the function of major organs, including the kidneys. Doctors and nurses must recognize low urine output and promptly treat the patient with fluids.  This treatment is known as a “fluid challenge” and if it does not resolve temporary and treatable causes of low urine output such as hypovolemia or dehydration, an infusion of fluids should prevent the patient from developing shock while the treating doctor determines the underlying cause.
  • Sudden or even gradual loss of motor function or sensation in the arms or legs, the onset of abnormal sensations such as numbness, tingling, or pins and needles, a cold or pale limb, or hypersensitivity in parts of the arms or legs may represent an emergency requiring immediate evaluation by a medical specialist or surgery.  Based on the patient’s presenting complaints, history, and other relevant information obtained during the hospitalization, the onset of some or all of these symptoms may require doctors consider whether the patient is suffering from life altering conditions such as limb ischemia, which is a condition where the flow of blood through arteries in the arms or legs is blocked and insufficient to sustain the viability of tissues in the extremity, or potentially irreversible injury to the spinal cord or nerve roots due to compression by bone, herniated vertebral discs, or an infectious mass.  A patient with abnormal motor or sensory function of the arms or legs will requires immediate evaluation by a specialist such as a neurologist, neurosurgeon, or vascular surgeon, with the determination of which specialist depending on the patient’s complaints, history, symptoms, and the results of physical and diagnostic testing and lab work.
  • Blood samples are routinely drawn from patients to monitor for derangement of the normal components of the blood.  An “H & H” is a term for a blood test which measures the amount of hematocrit and hemoglobin in the blood.  An elevated hematocrit may be caused by dehydration or other abnormal conditions which cause an increase in the number of red blood cells in the blood.  Low hematocrit or hemoglobin is a potential sign of unrecognized bleeding within the body.  Another common test known as a complete blood count (CBC) with differential requires lab technicians separate the components of blood and calculate the percentage of different types of cells in the blood.  An abnormally high level of white blood cells in a sample can alert doctors to the presence of infection or other disease.

The tools doctors and hospitals need to keep patient’s safe and avoid medical errors are at their disposal.  However, nurses, doctors, and hospital administrators often fail to take the time to read the information before them, and recognize when a patient who was once stable is on the verge of deterioration into serious injury, or death.

The attorneys, nurse paralegals, and administrative staff at Meyers Evans Lupetin and Unatin use their own process to identify people who suffered catastrophic loss from avoidable medical errors.  Our work is as important to the family of a loved one as the care they expected to receive when they trusted their loved ones life to a doctor or hospital.  We take every case, every individual, seriously.

All articles in this blog are the collaborative effort of attorneys Jerry Meyers, Brendan Lupetin, and Gregory Unatin.

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