Decision Making Case Analysis. From the following case please provide me with yo
ID: 127582 • Letter: D
Question
Decision Making Case Analysis. From the following case please provide me with your assessment as to what was wrong and who was or was not at fault in the case. More specifically I am looking for you to provide discussion on what the problem is, alternative identification of issues within the case, your analysis and evaluation of the situation within the case, and your solution to the problems and alternative issues you have provided. DISCUSS, NOT SIMPLY BULLET POINTS.
Case:
The plaintiff, age fifty-two, went to the emergency department of the hospital in March 2005. He had experienced transient episodes of blurred vision and also had a numb right hand. He was examined by a doctor and nurse “A”. The plaintiff’s symptoms quickly resolved and a CT scan did not reveal abnormalities.
The doctor diagnosed a transient ischemic attack and contacted the plaintiff’s treating physician. The plaintiff’s treating physician arranged transfer to the hospital’s telemetric monitoring area and requested neurological evaluation. Before the transfer occurred, the doctor and nurse “A” reassessed the plaintiff and detected no neurological abnormalities.
About twenty minutes later the plaintiff was examined by another nurse, “B”, who noted slurred speech, confusion and weakness on the right side. The symptoms were reported to the emergency department and Nurse “B” was told that these symptoms had not been present in the examinations by the doctor and nurse “A”.
Nurse “B” then contacted the doctor who then requested an immediate neurological consultation by a neurologist. The neurologist examined the plaintiff over an hour later. The neurologist considered the use of tPA, but the plaintiff had been at the hospital for over six hours at that time and the neurologist determined that the three-hour time for administration of tPA had passed. Further observation was recommended.
The plaintiff’s symptoms worsened. By the next day it was determined that the plaintiff had suffered a full stroke. The plaintiff was transferred to another hospital and was hospitalized for several weeks. He achieved significant recovery, but continued to have partial paralysis of his right arm, aphasia, mild impairment of cognitive functions, and foot drop of the right foot. He requires a cane, but can independently perform most of his everyday activities.
The plaintiff alleged negligence in the failure to timely diagnose and treat the stroke. The plaintiff claimed that the stroke was caused by a clot which traveled to the brain and could have been treated with tPA.
The defendants claimed that tPA would not have provided any benefit to the plaintiff. Additionally, the neurologist claimed that Nurse “B” could not accurately determine the time of the onset of the symptoms and that the first two examinations by the doctor had been concluded more than four hours earlier.
Nurse “B”, however, claimed that she reported to the neurologist that the symptoms had begun less than three hours prior to the examination.
The doctor claimed that her order for an immediate neurological evaluation was all she was required to do. The defendants also claimed that the stroke was due to circulatory obstruction caused by a dissection of the left internal carotid artery, which was confirmed by angiography.
Explanation / Answer
The person experiencing early signs of stroke such as numbness of lomb and vision problem when he admitted in the hospital. An early diagonosis of any of the symptoms such as face drooping, arm weakness, speech difficulty would indicate the emergency medical attention. Medical team should identify the signs and start treatment immediately. Physical examination include checking the blood vessels, blood tests to find out any clot, CT scan to reveal conditions in brain, or a carotid ultrasound to check blood flow.
In the initial examination, the doctor and nurse A should have to find it out. If delayed the complications might occur. Treatment within three hours of early dtection of any signs and symptom improve the prognosis. Again after twenty minute, nurse B found more neurological symptoms of stroke and reported to emergency department. If the neurological evaluation and consultation was done immediately, the patient could be treated early. An ischemic stroke would have been found out and treated as soon as possible.
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