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Dr. SH
Dr. SH, Board Certified Physician
Category: Medical
Satisfied Customers: 8770
Experience:  Doctor of Medicine
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, My Mother passed away after vomiting while on -PAP, she

Resolved Question:

Hi, My Mother passed away after vomiting while on BI-PAP, she was in hospital at the time. After the nurses tried to suction her, the doctor put a DNAR in place then placed her back on the BI-PAP, She Had a pulse and Agonal breathing. Could you tell my why the doctor would place her back on the BI-PAP please?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. SH replied 2 years ago.
Dr. Shahzad MD :

Hi there. Thank you for your question. I will be helping you out with your queries

Dr. Shahzad MD :

What was her age?

Dr. Shahzad MD :

What was her diagnosis? COPD?

Dr. Shahzad MD :

Please list medical problems that she had.

Dr. Shahzad MD :

Thank you

Customer:

HI, Thank you. She was 71, she had COPD, she was in type two respiratory distress. She had non insulin controlled Diabetes. She had in the past Lung cancer which was cured by radiotherapy many years ago. She also had Bi-Polar, and had suffered from a Neuroleptic malignant syndrome after an injection of Haloperidol in the late 80's.

Dr. Shahzad MD :

oh ok, really sorry to know that

Dr. Shahzad MD :

Her lungs were in pretty bad shape considering the fact that you mentioned that she was in type 2 respiratory failure.

Dr. Shahzad MD :

which is why I presume she was DNAR.

Customer:

Yes, she was end stage, however we as a family hadn't put the DNAR in place, the doctor who attended her after she vomited while on BIPAP did. What I don't understand is what would putting her back on BIPAP achieve?

Dr. Shahzad MD :

I understand your thinking here.

Dr. Shahzad MD :

By putting her again on BI-PAP they were attempting to continue positive airway pressure.

Customer:

Would it to be to hasten her death?

Dr. Shahzad MD :

No not really

Customer:

Yes, they turned the settings up

Dr. Shahzad MD :

It would not hasten her death at all.

Dr. Shahzad MD :

Invasive ventilation was not an option in her case.

Dr. Shahzad MD :

Putting her back on Bi-PAP I think was the right thing to do because they could not go for invasive ventilation.

Dr. Shahzad MD :

Turned up the settings because her blood oxygen levels must have been falling.

Dr. Shahzad MD :

She must have aspirated some of the stomach contents after vomiting which is what exacerbated everything.

Customer:

She did, her cause of death was aspiration of stomach contents.

Dr. Shahzad MD :

Yup that's what I though. She already was in end stage respiratory failure and on top of that the aspiration was what caused worsening in the lung function.

Customer:

She couldn't get the mask off herself, a nurse walked past her room and found her with her arms in the air trying to remove it. Can you tell me how long after vomiting and aspirating it would have took her to lose conciseness?

Dr. Shahzad MD :

Well, we can't say for sure.

Dr. Shahzad MD :

It varies from person to person and how much aspiration has happened

Dr. Shahzad MD :

Quite often patients may not lose consciousness but considering that she was already in end-stage lung disease is why she lost consciousness because there was not enough oxygen going to the blood.

Customer:

ok, would putting her back on the BI-PAP not have pushed the vomit further into her lungs therefore making things worse?

Dr. Shahzad MD :

No

Dr. Shahzad MD :

I understand your thinking

Dr. Shahzad MD :

But the staff did some suction.

Dr. Shahzad MD :

Must have taken out the bits and pieces they could.

Dr. Shahzad MD :

the stuff that had already gone it cannot be taken out. It must have caused sudden worsening of the oxygen level.

Dr. Shahzad MD :

So I think they did their best and I would have done the same.

Customer:

Yes, however when my sisters arrived at the hospital, they found her sitting upright in her bed, vomit coming out of her mouth and nose with her head tilted to the side, she had passed away and were not informed? If they had suctioned properly surely the vomit wouldn't have been there at that stage?

Dr. Shahzad MD :

I agree with you here.

Dr. Shahzad MD :

Probably they did not suction properly.

Dr. Shahzad MD :

That is one thing that could have been done better.

Customer:

I feel they did not try hard enough and because of her condition when she was admitted felt she wasn't worth trying to save. They also failed to do a risk assessment for the bipap and used the mask off licence as she had vomited twice in the ambulance prior to arriving at hospital

Dr. Shahzad MD :

hmmm

Dr. Shahzad MD :

I totally agree with you on that.

Dr. Shahzad MD :

There may have been some complacency among the ranks of the staff that were managing her.

Customer:

I totally agree, the doctor who attended her, "forgot" to right in her notes that she had died and wrote it two day later when he returned to work. Also his initial cause of death was COPD, I had to get it changed 6 months later to Aspiration of gastric contents.

Dr. Shahzad MD :

hmm, that's not too good from the doctors.

Customer:

Also she was certified dead 12 hours after being in the morgue???

Dr. Shahzad MD :

Yeah, there has been a lot of complacency there.

Dr. Shahzad MD :

that's not good enough as professionals.

Dr. Shahzad MD :

I am totally with you on this.

Customer:

As a family we feel very frustrated about this, we have highlighted all these points via a solicitor however the hospital have denied any liability, Our next stage is to go to court, however I'm worried about the costs if we lose, but feel we do have a case and they need to be accountable.

Dr. Shahzad MD :

I totally agree with you

Dr. Shahzad MD :

You have done the right thing here.

Dr. Shahzad MD :

There was complete lack of communication and professionalism.

Customer:

Thank you. The hospital have said she was going to die anyway so the biped was the only option. They didn't discuss the risks involved, she also had massive thick secretions from the COPD which my sister told them about. Sh wasn't given a palliative option, we feel they placed her at risk and she paid the ultimate price for that, she was robbed of a peaceful dignified death.

Customer:

BI_PAP

Dr. Shahzad MD :

I totally agree. It was very unprofessional on part of the hospital staff.

Dr. Shahzad MD :

Anymore questions that you would like to ask or anything else that you would like tot add?

Dr. Shahzad MD :

to add**

Customer:

Do you still feel putting her back on the BI-PAP after vomiting was the right thing to do?

Dr. Shahzad MD :

I think that the fault was with inappropriate suction

Dr. Shahzad MD :

and not keeping you well informed

Dr. Shahzad MD :

Suction SHOULD have been done right away and appropriately.

Customer:

I agree. Ok thank you for taking the time to talk to me and answer some questions and just to listen. Its very much appreciated.

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