Epinephrine overdose in E.R.

[bhoward574]

What is the name of your state (only U.S. law)? Indiana
Do I have a case? I recieved an overdose of epinephrine administered by nurse in I.V.
E.R. Doctor noticed mistake and said should have been in muscle. Dr. called cardiologist and began treating me for a cardiac arrest. My blood pressure and heart rate was very high.
My chest hurt and my head felt like it was going to explode. When things calmed down I told Doctor that on right side of head was worse headache I ever had. Left hospital that way.
Next day headache very bad and start of memory issues. See family Doctor and he wants CT of brain. CT shows aneurysm at spot of complaint. I had intercaranial surgery to remove aneurysm a year ago. I still have daily headaches and short term memory lose. The Neurosurgeon says that the headaches and memory issues are not from the surgery but from the incident before.
Can somone help me with this? I know it can be argued that the aneurysm was already there. BUT I did not walk in there with a headache! I did not walk in there with memory lose! I did not walk in there with chest pains! All of these I walked out with and still have.
On the bright side the hospital never sent a bill.(yet) For that matter it was very hard to get any info from that date.

 

[ecmst12]

It sounds like there are some complicating factors in your case. Already more then a year has gone by and the SOL is 2 years. I don't know whether you have a case or not, but I know you'd better consult a lawyer YESTERDAY so that you can find out before it's too late to do anything about it.

 

[lealea1005]

What brought you to the ER? Why were you given the epinepherine?

 

[FlyingRon]

I can't be sure in this case, but epi is used in two strengths for two different things. At the 1:1000 concentration it is injected into muscles to stave off severe allergic reactions. At 1:10,000 it is injected IV to treat certain cardiac dysrhythmias (generally arrests).

Injecting 1:1000 IV is like hitting someone's endocrine system with a sledge hammer. Heart, brain, muscles are all going to be affected.

It's one of those things they stress you get right in paramedic training (we carry both). I've heard of it happening before and it is extremely life threatening.

Yeah, you should be seeing a lawyer.

 

[lya]

Giving the correct dose and concentration of epinephrine via an incorrect route does not equal giving 1:10,000 vs. 1:1000.

If the OP had been given 1mg of epi as we give in code situations or near-code situations, I don't think a headache would be his complaint, whether or not he had memory loss.

IV administration produces a rapid onset of action; intra-muscle administration produces a slower onset of action. Therein lies the problem, not the dose or the concentration of the medication.

We have to assume the patient was a normally healthy individual who disclosed his prior aneurysm surgery of a year prior and that IM epi was acceptable practice.

The nurse failed to administer the medication via the correct route. This is the act of negligence/professional malpractice.

Corrective actions were taken by the MD.

The headache started the next day and a CT scan shows the aneursym to have recurred and to be currently visible (CT scan). When was the last CT scan of the aneursym prior to the administration of epi?

I think the IV epi caused a significant rise in blood pressure and a significant rise in heart rate, which led the MD to consult and treat for an impending heart attack, not cardiac arrest (which would have required more epi). I believe the heart may have suffered bruising from the increased force of contractions. I believe the aneursym may have been affected by the increased blood pressure; but, the blood pressure returned to normal in a short period of time. I have no idea as to the status of the aneurysm prior to the administration of epi.

I think if there is a viable claim, it will hinge on whether or not the IV administration of epi caused the aneursym to increase in size and remain increased in size, thereby placing pressure on the brain and causing memory loss and headaches and causing the patient to require additional treatment to resolve the problem(s) with the aneurysm.

I cannot tell if the repair of the aneurysm was a year prior to the epi IV administration or if the aneurysm repair and epi error occurred in the same year.

A medmal attorney may be willing to investigate the OP's claim. One year of a two-year statute of limitations does not allow the attorney much time to investigate. The advice to consult with an attorney "yesterday" is appropriate!

 

[bhoward574]

What brought you to the ER? Why were you given the epinepherine?

Allergic reaction to somthing I ate night before.

 

[bhoward574]

Giving the correct dose and concentration of epinephrine via an incorrect route does not equal giving 1:10,000 vs. 1:1000.

If the OP had been given 1mg of epi as we give in code situations or near-code situations, I don't think a headache would be his complaint, whether or not he had memory loss.

IV administration produces a rapid onset of action; intra-muscle administration produces a slower onset of action. Therein lies the problem, not the dose or the concentration of the medication.

We have to assume the patient was a normally healthy individual who disclosed his prior aneurysm surgery of a year prior and that IM epi was acceptable practice.

The nurse failed to administer the medication via the correct route. This is the act of negligence/professional malpractice.

Corrective actions were taken by the MD.

The headache started the next day and a CT scan shows the aneursym to have recurred and to be currently visible (CT scan). When was the last CT scan of the aneursym prior to the administration of epi?

I think the IV epi caused a significant rise in blood pressure and a significant rise in heart rate, which led the MD to consult and treat for an impending heart attack, not cardiac arrest (which would have required more epi). I believe the heart may have suffered bruising from the increased force of contractions. I believe the aneursym may have been affected by the increased blood pressure; but, the blood pressure returned to normal in a short period of time. I have no idea as to the status of the aneurysm prior to the administration of epi.

I think if there is a viable claim, it will hinge on whether or not the IV administration of epi caused the aneursym to increase in size and remain increased in size, thereby placing pressure on the brain and causing memory loss and headaches and causing the patient to require additional treatment to resolve the problem(s) with the aneurysm.

I cannot tell if the repair of the aneurysm was a year prior to the epi IV administration or if the aneurysm repair and epi error occurred in the same year.

A medmal attorney may be willing to investigate the OP's claim. One year of a two-year statute of limitations does not allow the attorney much time to investigate. The advice to consult with an attorney "yesterday" is appropriate!

No prior surgery. Sorry for time line. Got ahead of myself. Regardless of the aneursym before or after the epi. What about the medical issues that I am facing right know with the headaches and short-term memory loss that the nerologist says is not from the aneutsym?

 

[FlyingRon]

Giving the correct dose and concentration of epinephrine via an incorrect route does not equal giving 1:10,000 vs. 1:1000.

Pay attention to the information given in the original post. He was given something that was supposed to be given IM (subsequently indicated for an allergic reaction) in an IV. The supposition of the 1:10000 vs. 1:1000 is entirely supported.

If the OP had been given 1mg of epi as we give in code situations or near-code situations, I don't think a headache would be his complaint, whether or not he had memory loss.

IV administration produces a rapid onset of action; intra-muscle administration produces a slower onset of action. Therein lies the problem, not the dose or the concentration of the medication.

He already stated he was given an excessive does. That contradicts your hypothesis that it was just a means of administration problem alone.

Obviously those involved have already identified exactly what screw up happened. The only issue is how much of the resulting claim derived from that piece of negligence versus what was just the exposure of a preexisting condition. Both sides will present evidence to support their own claim.

 

[lya]

Giving the correct dose and concentration of epinephrine via an incorrect route does not equal giving 1:10,000 vs. 1:1000.

Pay attention to the information given in the original post. He was given something that was supposed to be given IM (subsequently indicated for an allergic reaction) in an IV. The supposition of the 1:10000 vs. 1:1000 is entirely supported.

He already stated he was given an excessive does. That contradicts your hypothesis that it was just a means of administration problem alone.

Obviously those involved have already identified exactly what screw up happened. The only issue is how much of the resulting claim derived from that piece of negligence versus what was just the exposure of a preexisting condition. Both sides will present evidence to support their own claim.

OK, Ron. We'll go with your way. The nurse not only administered the drug via an incorrect route but administered the wrong dosage because she/he used the incorrect drug concentration and she used at least two or three ampules/vials in order to give the ordered dosage. Happy now?

For you that don't know:

epinephrine 1:10,000 = .1mg per 1ml.

It is used on code situations to jump start the heart as in an adrenalin rush (CNS response). In a code, this concentration may be repeated every minute as needed/ordered. The onset of the drug's action is instantly and the effects last to 20-30 minutes.

epinephrine 1:1000 = 1 mg per 1ml.

It is given IM or SubQ for allergic reactions and certain respiratory problems. Either route, IM or SubQ, has an onset of 5-10 minutes and lasts 20-30 minutes. The entire ampule or vial of epinephrine is not usually given. Usually, only .2 - .3ml or so is given, yielding a dose of .2 - .3mg dose.

It would take two ampules/vials of epi 1:10,000 to give a .2mg dose; and, three ampules/vials to give a .3mg dose; thus, the higher concentration of 1:1000 is available for IM or SubQ administration.

Ron, I just can't stand it. I want you to explain to me how giving an entire vial/ampule of 1:10,000 (which equals .1mg of epi) is worse than administering/giving all or part of 1mg as in the 1:1000 preparation. It is the route that caused this patient to have such a rapid and severe onset of CNS response. Just because the OP says he got an overdose does not mean he got an overdose. More likely than not, he means he got too much of a response from the medication. I guarantee you, giving .2mg or .3mg IV to a healthy person with an allergic reaction is not going to have the desired effect.

 

[lya]

No prior surgery. Sorry for time line. Got ahead of myself. Regardless of the aneursym before or after the epi. What about the medical issues that I am facing right know with the headaches and short-term memory loss that the nerologist says is not from the aneutsym?

When did you first find out you had an aneurysm? (I'm still having trouble with your time line)
I need to be clear on the timeline of events before I answer your questions about your current status.

 

[ecmst12]

I think the aneurysm was discovered AFTER the epi, then the surgery was performed, all of this being more then 1 year ago, hence my advice to skip the message board advice and get straight to a lawyer before the SOL gets any closer.

Is it not possible that the wrong BOTTLE was picked up, and the more concentrated doseage was given IV? Same amount of liquid, more drug?

 

[lya]

I think the aneurysm was discovered AFTER the epi, then the surgery was performed, all of this being more then 1 year ago, hence my advice to skip the message board advice and get straight to a lawyer before the SOL gets any closer.

Is it not possible that the wrong BOTTLE was picked up, and the more concentrated doseage was given IV? Same amount of liquid, more drug?

The more concentrated vial is the appropriate vial. IM and SubQ injections are small amounts, part of the concentrated vial. The less concentrated vial is IV and has one thousand times less drug available than does the concentrated vial.

---I know this is coming out clear as mud, so I keep trying. The MD ordered the drug to be given IM. To give enough to stop an allergic reaction/response, the usual dose is .2mg - .3mg IM or SubQ. This was ordered IM. To use the 1:10,000 concentration, three ampules/vials would have to be used and the total volume to be injected would be either 2ml or 3ml. SubQ is not given in those amounts and since IM was ordered, it has to be the same concentration as would be used for SubQ. Therefore, the only concentration that can possibly be a choice is the more concentrated 1:1000 and only a part of the 1ml was given. Using 1:1000, .2ml or .3ml would have been given. That is an appropriate amount for SubQ; thus, it is appropriate for IM, also.

If the patient had been given .2ml or .3ml of the lesser concentrated epi (1:10,000), he would have received one thousand times LESS medication than his condition required and his allergic response would have continued unabated. He also would not have had a rapid onset of the severe symptomology that he experienced.---

OK--back to the OP's memory loss. If the neurosurgeon is willing to testify with evidence that the aneursym's presence did not contribute to the headaches and memory loss and if that testimony is supported by medical records prior to the epi incident, then, I believe it will become a battle of testifying experts.

The defense will argue that the aneurysm had more to do with damage done to that part of the brain than did the epi. Without a prior CT of the head, specific to the location of the aneurysm, how will the plaintiff successfully argue that the aneurysm is a noncontribuing co-incidence?

Memory loss and headaches can occur following a simple concussion that produced no other longterm effects. I suppose it can be argued that the epi's rapid onset, which triggered a sudden, significant CNS response, caused a concussion 'from the inside out'.

Anyway, the correct answer is to consult with a medmal attorney ASAP.

I guess we should also advise that medmal claims, if accepted, progress slowly and it takes years to complete the process.

 

[lya]

I'm so confused now about epi concentrations, I'm going to bed.

But--not before I add that in codes, we do use 1:10,000 but we use 10ml injection "jets" that give 1mg.

Now--I'm going to bed.

 

[lealea1005]

I'm so confused now about epi concentrations, I'm going to bed.

But--not before I add that in codes, we do use 1:10,000 but we use 10ml injection "jets" that give 1mg.

Now--I'm going to bed.

Night-Night, Lya. Hope you didn't have vision of epi ampules dancing in your head.

(PS: I thought your explanation was as clear as day )

 

[bhoward574]

When did you first find out you had an aneurysm? (I'm still having trouble with your time line)
I need to be clear on the timeline of events before I answer your questions about your current status.

I found out about the aneurysm after the ct scan.
I will start this over since I did leave out a lot of details. On 11/11/07 I entered hospital healthy 39year old no prior history of aneurysm, no prior history headache, for allergic reaction to something I ate night before. Nurse administered epi 1/1000 at 0.4mg IV. This was to be administered IM. Doctor witnessed it just as she finished. He reprimanded her at that time in front of us(my wife and I). At this time they quickly moved me to the trauma room and treated for a heart attack given nitro and other . By that time I am feeling full effects of epi. If you have not experienced this it is not well explained. all my muscles flexed at same time. Heart felt like it was going to explode. My brain was on fire. I do have copy of nurse and ER doctor report but no hospital report.(they are not finished with.) 10 minutes before leaving hospital I stated that the right side of my head was going to explode and chest pain. (All of this documented on report) 8-10 pain scale. Hospital released me script in hand for some vicodin. 11/12/07 Wake up with worse headache of life,start to have memory issues. Call family Doctor he orders CT scan. CT showed 7 mm right middle cerebral artery.Referred to nero srg. Was told that surgery would stop head aches. On 12/19/2007 I had surgery for the aneurysm. This was intracranial so it has taken some time to find out if a pain is post op. or from something before the surgery.
Hence the headaches,Migraines,chest pains, and memory loss that I am being treated for now. Upon fallow up visits with Nero Serg. who did surgery, we ask about my conditions and he says they have nothing to do with surgery and has to do with what happened in hospital.
When I walked into the hospital I did not have a headache. I did not have chest pains.
I did not have memory issues.
After they administer the right dose in the wrong hole(save argument) of epi did I start to have these effects. I understand the argument of the aneurysm before or after the overdose of epi.(although I believe it affected it.) But what about my conditions that I have now that is directly related to the day I walked into the hospital. It just seems to be a no brain-er to me. Pardon the pun.
This experience has changed my life. Lost job, can't do what I could before. but I am so glad to be alive.... yea you go. Thank you all so much for your input did not think I would start such a big who-wra. By the did see locale lawyer says no chance after reviewing file 5 days. Me thinks somthings ups.