Texas Spinal Tap

[LAWMED]

Oh, and by the way, the consent is meaningless unless he was specifically told there was a high risk of bleeding around the spinal cord, need for surgery to evacuate that blood, and permanent spinal cord damage. Why are you contributing at all here? Basic informed consent issues, VERY SIMPLE and basic concepts in stroke treatment, and you have no clue....what do you get out of all this?

[LAWMED]

Originally Posted by Dogmatique

Treating something before a diagnosis is determined is not automatically malpractice.

If the patient presents in the ER with signs of a stroke there's a good chance he will be given a blood thinner. Do we want to prevent possible further damage, or wait until the diagnosis is confirmed and risk a much worse outcome which may have been lessened or avoided if the blood thinner had been given in time to halt the progress (or at least attempt such).

I can actually see a patient's family suing for not administering a potentially life-saving drug when the patient was showing signs of a stroke.

Sorry, 100% wrong in treating a stroke. You MUST come to a diagnosis of embolic stoke, which can only be reached after definitive testing TO RULE OUT hemorrhage stroke, and never includes an LP. Failure to do so can easily lead to a fatal outcome when the thrombolytic is given. Thrombolytics are not given 'in case' the patient has had an embolic stroke, but rather BECAUSE they have. Nor is it given to 'halt' or 'prevent further damage'...it is given to reverse the damage that has taken place before it becomes permanent.

[Proserpina]

Administering them to a hemmorhagic stroke patient would be 100% fatal, 100% of the time.

No, it wouldn't.

There's a higher risk of death, yes. But it is not 100%.

And for some pleasant reading...

[url]http://cme.medscape.com/viewarticle/561301[/url]

This one is also interesting...

[url=http://www.neurology.org/cgi/content/abstract/43/7/1298]Safety of anticoagulation after hemorrhagic infarction -- Pessin et al. 43 (7): 1298 -- Neurology[/url]

[lealea1005]

Originally Posted by LAWMED

I say again that there is no appropriate treatment scenario where the events could have been in the order the OP
described.

Which, again, is one of the reasons I say we were not there to examine the patient and need to give the examining Physician the benefit of the doubt. WE do not know what symptoms the patient presented with at the ER, the time frame of the events or the reliability of the patient's recollection of their experience. OP also never returned to answer the question regarding their actual discharge diagnosis or, for that matter, the actual symptoms bringing them to the ER.

At this time, with the information provided by OP, there is absolutely NO proof the standard of care was breached.

The informed consent WOULD have, among other risks, addressed the risk of bleeding, and the possibility of surgical intervention. It must be a while since you've witnessed a patient signing an informed consent.

Stupid? Far from it. Do you really want to risk losing credibility because you lower yourself to name calling?

[las365]

If nothing else, the discussion in this thread must surely have proved to OP that:

This seems like a no-brainer malpractice case to me !

This is just not the case. In fact, there is almost no such thing, ever, as a no-brainer med mal case.

OP, if you ever come back, in order to evaluate whether you have a viable medical malpractice claim, you must see an experienced med mal attorney who can have your medical records evaluated by the appropriate medical experts and who can assess your damages, if any, caused by the negligence (if you can prove negligence).

And, by the way, your non-economic damages in Texas are capped at $200K. And if your medical insurance paid for treatment that was made necessary by the negligence (if there was negligence), it gets paid back out of your recovery before you get anything.

[LAWMED]

Originally Posted by Dogmatique

No, it wouldn't.

There's a higher risk of death, yes. But it is not 100%.

And for some pleasant reading...

[url]http://cme.medscape.com/viewarticle/561301[/url]

This one is also interesting...

[url=http://www.neurology.org/cgi/content/abstract/43/7/1298]Safety of anticoagulation after hemorrhagic infarction -- Pessin et al. 43 (7): 1298 -- Neurology[/url]

You are wrong. Acute hemorrhagic stroke is an ABSOLUTE CONTRAINDICATION to the administration of thrombolytics (clot busting drugs given to dissolve embolism) as a medical intervention and would be expected to kill the patient every time.

Use of anticoagulants such as heparin, LMWH, and coumadin are CONTRAINDICATED and medically UNINDICATED treatment for acute hemorrhagic stroke patients.

The links you provide have absolutely nothing to do with the OP's scenario. They both relate to the treatment of patients with chronic atrial fibrillation, who are at risk for embolic stroke, with antigoagulatns as a preventative measure. The second one discusses the saftey of continuing chronic administration of anticoagulants after an anticoagulated patient then suffers an embolic stroke and associated hemorrhagic infarct. In other words, this is regarding patients who are taking anticoagulants for a heart condition and how to manage them should they have a stroke which includes bleeding in the brain.

The statements I made and the information I provided is absolutely accurate. Not because I am smarter than anyone, but because this is what I do for a living. It is NOT what YOU do for a living. I am sure there are a million things you know about your chosen field that I am ignorant of. I try to stick to what I know and ask questions about what I do not. I suggest you ask questions regarding this topic.

[LAWMED]

i have to admit that this will be the most valuable information the OP will take away from this discussion. Every inquiry should receive similar info. Since we do not just post this as an automatic response and then close out threads before additional discussion takes place (what fun would that be), additional information is appreciated by many OPs. In the end, seeking experienced professionals to properly evaluate claims is our creed.

Originally Posted by las365

If nothing else, the discussion in this thread must surely have proved to OP that:

This is just not the case. In fact, there is almost no such thing, ever, as a no-brainer med mal case.

OP, if you ever come back, in order to evaluate whether you have a viable medical malpractice claim, you must see an experienced med mal attorney who can have your medical records evaluated by the appropriate medical experts and who can assess your damages, if any, caused by the negligence (if you can prove negligence).

And, by the way, your non-economic damages in Texas are capped at $200K. And if your medical insurance paid for treatment that was made necessary by the negligence (if there was negligence), it gets paid back out of your recovery before you get anything.

[lealea1005]

Originally Posted by las365

If nothing else, the discussion in this thread must surely have proved to OP that:

This is just not the case. In fact, there is almost no such thing, ever, as a no-brainer med mal case.

Thanks, las. This was the point I was trying to make when I first replied to OP's thread ( and then again in a later post).

[LAWMED]

I sincerely retract my labeling anything or anyone 'stupid'. It was an inappropriate, immature lack of self control on my part in response to my frustration regarding the discussion.

Originally Posted by lealea1005

Which, again, is one of the reasons I say we were not there to examine the patient and need to give the examining Physician the benefit of the doubt. WE do not know what symptoms the patient presented with at the ER, the time frame of the events or the reliability of the patient's recollection of their experience. OP also never returned to answer the question regarding their actual discharge diagnosis or, for that matter, the actual symptoms bringing them to the ER.

At this time, with the information provided by OP, there is absolutely NO proof the standard of care was breached.

The informed consent WOULD have, among other risks, addressed the risk of bleeding, and the possibility of surgical intervention. It must be a while since you've witnessed a patient signing an informed consent.

Stupid? Far from it. Do you really want to risk losing credibility because you lower yourself to name calling?

[lealea1005]

Can you please point out where OP indicates s/he was diagnosed with hemorrhagic stroke?

[penelope10]

The scenario described by the OP also does not make sense to me based on my own experience with someone who had an aneurysm. Blood thinners are not given first and then a spinal tap.

Speaking from experience, I took my ex to the hospital after he had a terrible back ache and headache. They did a "spinal tap" first and discovered blood in his spinal fluid. A neurologist was immediately called in and then other tests were done. Ended up he had a lemon size blood clot in the core of his brain.No medications were given to him until the diagnosis was confirmed. He was not a candidate later for many medications for his headache because they could cause reactions with the drugs he was taking and kill him--in other words cause his blood to become too thin. After waiting about a week it was determined that the clot would have to be removed surgically.

[CJane]

Originally Posted by lealea1005

Can you please point out where OP indicates s/he was diagnosed with hemorrhagic stroke?

Also, where surgery was required to fix the bleed, and where he was paralyzed?

I'm missing ALL of those components that it's being insisted MUST have occurred.