DukeIceFrog15
Coroner’s case Background: Maya is the only daughter of Aishwarya…
Coroner’s case
Background: Maya is the only daughter of Aishwarya and Arhann Rai who immigrated to Australia 2 years ago.Maya has awakened with a headache and later begins vomiting. Her mother checks her temperature (36.8 degrees Celsius) and decides to give her paracetamol and keep her fluids up. Maya spends the day resting at home.
Presentation: January 3rd 17:33 hours : Maya a 8-year-old girl was brought to the Emergency Department (ED) of New Queensland University Hospital with a short history illness which included fever, vomiting and diarrhoea by her parents Aishwarya and Arhann Rai.
Wait time notification on arrival at the Emergency Department indicates a 4-6 hour wait for treatment.On initial assessment at ED triage:
Suspected diagnosis is gastroenteritis.
Reason for presentation: fever and high heart rate (no observations documented)
Her mother (Aishwarya) (noted to be softly spoken and English a likely second language) expressed concerns about Maya’s cold hands.
Australasian Triage Score: 4 (time 17:35 hours).
Post her triage the family and Maya were transferred to the ED waiting room.
17:37 Maya’s mother approaches the triage window; she appears anxious and concerned about Maya as her daughter had vomited and her hands are cold. The RN observes Maya’s father rubbing her hands and indicates that someone would see them shortly, but the ED is very busy.
17:41: Maya’s mother raises concerns to the triage nurse that spots have appeared in her daughters eyes. The RN notes that the mother appears anxiousand it is difficult to determine the basis of the concern clearly.
The triage RN requests a Junior doctor to attend who discussed their concerns. He assumes that she has presented to ED because of an eye issue, which is assessed as non-urgent and then returns to the ED to attend to other patients (17:42 hours).
17:49: An RN and nursing student meet with the family and initiated the commencement of vitals signs. Maya’s mother asks the RN how long she may have to wait until a doctor would see Maya and that she seemed to have a temperature. The SpO2 monitor is documented as reporting an SpO2 90% and is not picking up the reading well, at which time the student RN goes to obtain a different observation monitoring device. The SpO2 sensor was applied by the RN to Maya’s foot as her hands are cold. The documented is SpO2 93% on room air.
18:00 hours: Nursing assessment completed:
Temperature 38.9 degrees Celsius.Parental concern on the Pediatric Observation chart was scored as a zero because the RN had allayed the parents’ concern.SpO2 93% on room air.
Respiratory rate 29 breaths/min.
Pulse rate 128 beats/minute.
Due to feeling unwell Maya was lying on the waiting room floor and appears lethargic.
18:50 hours: RN assigned to oversee patients in the waiting room provided handover to relieving RN and went for a break. Handover information pertaining to Maya included observe her further post oral fluids and try to reduce her fever with medication.
19:00 hours: Mother approaches relieving triage RN pleading to have a doctor review her daughter as she was very unwell and can barely speak. Relieving RN indicates that she will attempt to get a doctor soon, but they were very busy.
19:06 hours: Ibuprofen was attempted to be administered by the RN to treat the presence of fever and noted that Maya was unable to take the oral medication and appeared very lethargic.
19:09 RN reports to ED registrar that Maya unable to take medication and appeared unwell and raised her concerns to the ED registrar.
19:09 hours Maya is reviewed by the ED consultant and appeared floppy. The consultant was concerned that she maybe suffering from a neurological condition and transferred her to a resuscitation bay in the ED.
19:18 hours: An arterial blood gas (ABG) taken. The result of the ABG could not be processed as the machine was broken. Blood cultures and additional blood pathology specimens obtained (Full blood count, coagulation profile, urea, creatinine and electrolytes, liver function tests).
19:25 hours: IV access obtained and IV fluids administered to address hypotension.
20:00 hours: SpO2 89% on 6L/min via Hudson mask, respiratory rate greater than 30 breaths/minute, heart rate 149 beats/minute, significant hypotension noted. Decision made to electively intubate.
20:05 hours: Patient intubation and in cardiac arrest. Cardiopulmonary resuscitation commenced.
21:04 hours: Maya is declared deceased.
Questions:
1. Analyse the Coroner’s case to identify the issues (what happened and why it happened) in care delivery that contributed to a failure to recognise and respond to clinical deterioration. Discuss how the issues identified, in conjunction with the patient presentation, medical history, and underlying pathophysiological processes led tothe clinical deterioration.
2. Based on contemporary evidence analyse the clinical actions that the registered nurse(s) implemented, how this contributed to the patient’s clinical deterioration, and discuss what action should have been undertaken to potentially prevent the clinical deterioration.
3. Based on issues identified in the Coroner’s report apply contemporary research to discuss the communication barriers in the escalation of care and how these may be addressed to improve future care.
