Anonymous
Anonymous asked in Science & MathematicsMedicine · 4 weeks ago

Is this medical negligence?

If i present my son to ED and he walks in there unaided on hes own complaining of headaches dizziness. Having returned from holiday prior 4 weeks bloods are taken and the readings are high crplevels and high lactic ? The bloods then sit there and nobody discusses the high readings with microbioligist or Dr untill 16 hours later in that time he’s admitted to a ward and just left with no observations or careplan a septic screen reading was taken on entering A&E was left blank. A set of 6 intravenous antibiotics were not administered so the outcome is 4 strokes and infective endo carditis. Turned out to be sepsis even thoa the staff believed it to be malaria because of the holiday trip, again no medicine administered for the malaria which the tests came back negative. Could the strokes and heart disease  be avoided?? 

Update:

As lsi he tells the nurse hes had a temprature of 41 and one time however when they twke the temp its 36 but they gave him paracetmol and ibuprofen 

2 Answers

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  • 4 weeks ago

    I don't know how things are done in the UK since you mentioned A&E but in the US tests that can have critical consequences when found to be low or high, have what is called critical values, if that result exceeds a certain critical level then it is mandatory to call the nurse taking care of the patient or the doctor of that patient. That call is documented. Lactic acid levels have critical limits and require a call when found to be critically high. When it comes to sepsis in particular because of the high mortality rate associated with sepsis many institutions in the US have developed code sepsis protocols when a patient presents to the emergency room. The goal is to institute antibiotics a quickly as possible when the criteria are met basically on clinical signs and symptoms and laboratory testing inclusive of lactic acid levels. Although lactic acid levels are important that by itself is not specific for sepsis and institutions have added procalcitonin levels to provide more specificity to the diagnosis in providing a very high negative predictive value. That is if the procalcitonin is normal then they don't have sepsis.  

    My impression based on what you stated is that the criteria was not met for sepsis at the time of presentation. You mention a ten day interval in there. Things change with time. It is important to recognize the signs of sepsis and to institute the septic protocol so initiation of antibiotics can be instituted as quickly as possible. 

    There's more overt acute endocarditis and then there's more subtle forms like subacute endocarditis. Those organisms that cause those are somewhat different from the classic sepsis bacteria and the tests vary as to sensitivity and specificity in diagnosis. 

  • Anonymous
    4 weeks ago

    A high level of CRP in the blood is a marker of inflammation. It can be caused by a wide variety of conditions, from infection to cancer. High CRP levels can also indicate that there's inflammation in the arteries of the heart, which can mean a higher risk of heart attack.

    Lactic acid levels get higher when strenuous exercise or other conditions—such as heart failure, a severe infection (sepsis), or shock —lower the flow of blood and oxygen throughout the body. ... Very high levels of lactic acid cause a serious, sometimes life-threatening condition called lactic acidosis.

    Sepsis screening is as follows;

    NEWS is an aggregate score made up of six physiological parameters, with the aim of improving detection and response to clinical deterioration in acutely unwell patients. Parameters measured are:

    Respiratory Rate

    Oxygen saturations

    Systolic BP

    Pulse rate

    Level of consciousness (AVPU score)

    Temperature 

    https://www.rcgp.org.uk/clinical-and-research/abou...

    Unfortunately if his temperature had returned to normal, his sats were fairly normal and he was walking and talking the NEWS (national early warning score) wouldn't have picked up the sepsis so the antibiotics weren't given. It all depends on how high his CRP and lactic acid levels were as these are other reasons for them to be raised besides sepsis. A doctor would have reviewed his test results as a matter of course and as his malaria screening was negative there was no reason to treat him for it. You need to discuss this with a medical negligence solicitor.

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