Mr. Colin Lapse is a 54-year-old male admitted to ICU after surgery following a workplace accident on a construction site where he was a labourer. He was struck by in the abdomen by a spike from loaded wire that was being maneuvered by a crane. The wire broke off, knocked him off balance and perforated his abdomen. The site foreman, Ms. Joanne Charge ordered the crane to lift the load out of the way and as the worksite qualified first aider, she applied pressure to Mr Lapse’s abdomen and called an ambulance. Due to the injuries sustained Mr. Lapse became hypovolaemic and went into cardiac arrest. Ms Charge directed his co-workers to support delivery of CPR. With the arrival of the paramedics, ROSC was achieved, he was stabilised and transferred to the emergency department (ED). On arrival, Mr. Lapse’s vital signs were documented as: respiratory rate – 25/ min, use of accessory muscles noted, ECG heart rate was 120/min (sinus tachycardia), Temperature 36.5 degrees Celsius, blood glucose level was 7.5mmol/L, his GCS (Glascow coma scale) was 12/15 (Eyes 3 / Verbal 4 / Movement 5). Pupils were equal and reactive (size 2). His blood pressure was 105/80 mmHg. The triage doctor (Dr. Goode) ordered an urgent head, spine and abdominal CT. And a “full workup of blood tests”. He tried to discuss the situation with Mr. Lapse, however, the paramedics had given Mr. Lapse methoxyflurane and a total of 15mg IV morphine. He was very drowsy and seemed confused. Dr. Goode asked the patient “Who is your next of kin?” Mr. Lapse stated it was “Queen Ree”. Without further information Dr. Goode decided to proceed with the medical management plan and Mr. Lapse underwent the diagnostic tests and was returned to the resus bay in ED while waiting for the results of the scan. A short time later, while Dr Goode was reviewing the scan report which showed a small bleed in the liver, he heard shouting in the emergency waiting room and in the company of security, went to investigate. He saw a middle aged woman and an older man in a verbal altercation and asked what the problem was. The lady stated, “I am Ree Lapse, Col’s wife” she was quickly interrupted by the elderly man who stated, “She means ex-wife, I am Mr. Tymme Lapse, Col’s father and his medical treatment decision maker”. Mrs. Ree Lapse interjected and said, “I am still married to him” and Mr. Tymme Lapse stated, “not for long”. Dr. Goode asked both to respect the hospital environment and be mindful of other unwell patients. On turning to Charge Nurse Indira, Dr. Goode said, “Be sure to make a referral to social work, these people are crazy”. Charge Nurse Indira laughed and agreed. Both Ree and Tymme yelled at the Charge Nurse Indira, who told the security guard to “watch them” and walked off. As Dr Goode walked back to the resus bay, the nurse allocated to look after Mr. Lapse, Nurse Helmut, approached him and told him that the patient was becoming tachycardic and his blood pressure was dropping. Fearing the worst, Dr. Goode contacted the general surgeon and his best friend, Dr. Bill Duct for a surgical consult. Dr. Duct told Dr. Goode he was just coming back from lunch at the pub and would be a couple of minutes. On assessing Mr. Lapse, Dr Duct stated that if the patient was not operated on in the next 60 minutes, then he would die. Dr. Duct approached both Ree and Tymme for consent for surgery. Ree did not want the surgery but Tymme did. Reminded by Tymme that he was the medical treatment decision maker and given the patient’s situation, Dr. Duct proceeded with the operation. Ree screamed at him that she would “Get the lawyers to prevent him” and threatened Dr Duct. She was escorted from the hospital premises by security. Dr Duct took the patient to the theatre for surgery. Mr. Lapse was anaesthetised, and an endotracheal tube inserted, an IV canula was inserted by the surgeon and Nurse Maisy inserted an indwelling catheter. The insertion of the urinary catheter caused some bleeding and this was noted in the patient file. Nurse Maisy also told the scrub nurse, Abioye. During the surgery, the patient’s blood pressure kept dropping and the anaesthetist had difficulty maintaining a good output. Dr. Duct noted more extensive bleeding from Mr. Lapse’s liver than thought but could not explain why as there did not appear to be any bleeding from the liver post-surgical repair. The patient’s abdomen was closed with minimal bleeding was noted on the abdominal dressing. The patient was stable but in critical condition and transferred to the ICU to Nurse Chan. On ICU arrival, Mr. Lapse’s vital signs were documented as: respiratory rate – 18/ min, no use of accessory muscles noted, ECG heart rate was 100/min (sinus), Temperature 36.7 degrees Celsius, blood glucose level was 5.5mmol/L, his GCS was not recorded, pupils were sluggish equal and reactive (size 4). His blood pressure was 100/80 mmHg. Nurse Chan noticed the urine colour from the catheter bag to be claret in colour and 500 ml in the bag. There had been no mention of this from the ISBAR handover from theatre staff. Approximately 30 minutes after arrival into ICU, Mr. Lapse went into cardiac arrest and could not be resuscitated. The ICU registrar advised the coroner’s office of the death and arrangements were made to have police attend as is required. By this time, Ree had returned to the hospital with her solicitor and found out that Mr. Lapse was deceased. She declared that she was suing the hospital and Dr Duct for negligence and stated that all of the staff involved in the surgery assaulted her husband and demanded that the police arrest everyone for assault and battery and that they all are guilty of murder. That evening Nurse Chan sent an update on their Instagram page with a photo image of the catheter bag and a caption that said “Inserted by incompetent nurses in theatre and not handed over. How dumb can you be?” Nurse Indira, a friend of Nurse Chan replied comment with “Is that the patient with the crazy wife?”. NUR5011 – Contemporary Nursing in Context 1 – Assessment 2: Values/Ethics essay Criterion N –
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