In those rare cases where tragedy strikes, the support of Dental Protection is invaluable in several ways, as this case demonstrates...
A young dentist, graduated less than a year, was working as a Senior House Officer (SHO) in an oral surgery unit. A somewhat anxious, obese patient had undergone an osteotomy, which had been undertaken by a consultant oral and maxillofacial surgeon.
Over the next 48 hours, the patient developed extensive swelling around the head and neck. The young SHO was on call over the weekend during, which the patient’s condition was to deteriorate.
Immediately following the surgery, the theatre recovery staff informed the SHO of excessive bleeding from the patient’s nose and mouth. A catheter was placed in the nasal airway, the other nasal orifice being occupied by the nasopharyngeal tube.
That day, the patient was uncomfortable but stable, but unfortunately slept very little. During the following day the patient became increasingly agitated as considerable swelling of the face and neck made his breathing progressively more difficult.
He wanted the nasopharyngeal airway removed, but he was told this was necessary to maintain his airway and to make his breathing easier. Much effort by the SHO and nursing staff was necessary to reassure and calm the patient, and ice packs were used to control the swelling and thereby give the patient some relief. Extremely anxious
In the early hours of the following morning the nursing staff contacted the SHO while on call, as the patient was becoming extremely anxious. Over the telephone (from his bed) the SHO advised 10 milligrams of diazepam to be administered rectally – not a particularly large dose for a patient weighing some 17-and-a-half stone – to reduce his anxiety and hopefully assist his breathing.
The SHO was aware that diazepam is a respiratory depressant, but felt that at such a low dosage the benefits would outweigh the disadvantages. Unfortunately, the SHO was not aware at the time that the patient had already been given two intra-muscular doses of morphine in order to settle him down during the night. Diazepam and narcotics are both respiratory depressants and are synergistic.
Within an hour or two the SHO was urgently summoned to the patient’s bedside, but during the three minutes it took him to get there the crash team was already positioned around the patient. The patient had gone into respiratory and then cardiac arrest and after several unsuccessful attempts at resuscitation the SHO and the on-call Anaesthetic Registrar performed a cricothyroidotomy. The Oral Surgery Registrar finally arrived and carried out an emergency tracheotomy much to the relief of the SHO.
Severe brain injury
The Consultant Surgeon arrived about an hour later. Although transferred to intensive care, it became clear that the patient had been anoxic and had suffered severe brain injury. The patient was left in a permanent vegetative state for a few more months, during which time he suffered severe and recurrent antibiotic-resistant chest infections and tragically he died just a few months later.
The SHO was involved in internal enquiries and investigations at the hospital, looking into all aspects of the patient’s care and management including the SHO’s action and the nursing care, and he was later required to give evidence at the inquest.
As one would expect, the young dentist was severely traumatised not only by the harrowing events at the time, but obviously by the patient’s subsequent death. He needed considerable help and support at a human level, as well as sound professional advice and legal representation to protect his position at the internal hospital enquiry and subsequent Inquest.
None of this was provided by his employer’s indemnity and he was able to appreciate at first-hand how invaluable it is to have taken out additional indemnity in his own right.