Some time ago, the China Judgment Documents Network published a judgment on a case related to a medical damage liability dispute, involving a compensation amount of more than 810,000 yuan. At first glance, the amount of compensation is really huge, but it is actually a sad story, behind which is the birth of a new life and the loss of a living life.
Source: China Judgment Documents Network
Let the affected party take blood and delay the rescue!
The "Jingyuan County Maternal and Child Health Hospital, Wen Mou 1 and other medical damage liability dispute civil second-instance civil judgment" shows:
On October 30, 2019, the maternal Fan Mou gave birth in the Jingyuan County Maternal and Child Health Hospital, postpartum hemorrhage, the hospital had no blood to transfuse during rescue, let the relatives of the affected party go to get blood, delayed the best treatment time, resulting in the death of the maternal rescue ineffective shock, Jingyuan County Maternal and Child Health Hospital compensated the deceased's family for death compensation, funeral expenses, living expenses of the dependents, mental damage consolation money, transportation expenses, appraisal fees, and lost work expenses of 818228.31 yuan.
Case overview
1. At 19:12 on October 30, 2019, the deceased Fan went to the Jingyuan County Maternal and Child Health Hospital to be admitted to the hospital for inspection and delivery, and at 23:45 on the same day, he took LOA to deliver a baby girl.
2. Due to bleeding after giving birth, Jingyuan County Maternal and Child Health Hospital launched a rescue plan for postpartum hemorrhage. Since there was no blood to transfuse when blood transfusion was taken for treatment, the Jingyuan County Maternal and Child Health Hospital asked the relatives of the affected party to go to the blood source to take blood, and the postpartum hemorrhage treatment was not timely.
3. After the patient retrieved the blood, because there was no blood transfusion device, the patient was allowed to borrow, which delayed the best rescue time for the patient's life, and due to the ineffectiveness of rescue, Fan died of shock at 03:00 on October 31, 2019.
4. The medical records record that Fan's death diagnosis is: amniotic fluid embolism; multi-organ failure; postpartum hemorrhage; DIC.
It seems that the matter has come to an end, and the debate between right and wrong is meaningless, and this case is a wake-up call for our medical staff to learn from it and avoid the recurrence of similar tragedies.
Why can't the patient's family get blood?
In the rescue process, no matter what the reason is in the hospital, it cannot be a reason for the patient's family to go to the blood source to take blood.
According to the blood bank management measures, the blood collection personnel should be blood transfusion department staff or hospital staff who have undergone strict training and qualified assessment, and in any case, they should not assign unqualified and unqualified personnel to collect blood.
In addition, different blood products have strict transportation requirements, such as red blood cells need to be stored in an environment of 2-6 ° C, plasma needs to be transported at a temperature below -20 ° C, platelets need to be concussive, etc., so the blood transfusion department needs to be equipped with corresponding blood transport boxes to prevent blood products from being damaged and deteriorated during transportation, affecting the infusion effect.
As for why hospitals are in short supply of blood transfusion devices, it is not known. Probably the doctor never expected things to develop to such a serious extent.
If the blood transfusion is timely, will the patient still die?
Because no autopsy was performed after the patient's death, the specific cause of death is not clearly determined. If the patient is bleeding, whether the patient can definitely be rescued in time for blood transfusion.
The answer is also not necessarily.
Amniotic fluid embolism is the first diagnosis in the diagnosis of death. Amniotic fluid embolism itself is an extremely dangerous disease, with a mortality rate of more than 60%, which is the main cause of maternal mortality.
What is amniotic fluid embolism?
Amniotic fluid embolism refers to a series of serious birth complications with a series of pathological changes such as acute pulmonary embolism, anaphylactic shock, disseminated intravascular coagulation (DIC), and multi-organ failure during childbirth.
Amniotic fluid embolism has a rapid onset and rapid progression, and it needs to be detected early, treated as soon as possible, and immediately rescued. In addition to clinical manifestations and imaging studies, amniotic fluid embolism is also evidenced by laboratory tests.
Laboratory tests for amniotic fluid embolism
1. Blood smear to find tangible substances in amniotic fluid
The collection of inferior vena cava blood and microscopic examination of amniotic fluid can be used as a basis for the diagnosis of amniotic fluid embolism.
However, microscopic examination will always have a certain missed inspection rate due to the influence of various factors such as materials and microscopic personnel. In suspected patients, amniotic fluid embolism cannot be ruled out even if microscopic examination does not find formed points.
2. Laboratory tests related to DIC
Amniotic fluid contains a large amount of procoagulant substances, similar to tissue thromboplastin, after entering the maternal blood, it is easy to produce a large number of microthrombosis in the blood vessels, consuming a large number of coagulation factors and fibrinogen, resulting in DIC. Therefore, when pregnant women have unexplained DIC, they should also be wary of the possibility of amniotic fluid embolism.
At DIC, due to the consumption of a large number of coagulation substances and the activation of the fibrinolytic system, the maternal blood system rapidly changes from hypercoagulable to hyperfibrinolytic, the blood is not coagulated, and severe postpartum hemorrhage and hemorrhagic shock occur.
The early stages of DIC are relatively silent and rapid, requiring reliance on laboratory tests. When DIC occurs, laboratory indicators change as follows:
Blood routine: a large amount of coagulation is consumed in the early stages of DIC, so platelets will decline progressively, and when more severe bleeding occurs in the later stages, hemoglobin will be reduced accordingly.
Coagulation function: Most of the components of microthrombosis are fibrin, so there will be a decrease in fibrinogen content during coagulation function tests.
Because DIC has a hypercoagulable phase, a consumptive hypocoagulable phase, and a secondary hyperfibrinolytic phase. Therefore, early PT and APTT will be shortened, and after large consumption of late clotting factors and fibrinogen, PT and APTT will be prolonged.
Thrombocytopenia, APTT, prolonged PT, decreased Fg levels, and increased FDP and D-dimer levels are common diagnostic tests for DIC.
DIC diagnostic criteria at Massachusetts Medical Center:
As a healer, it is the duty of life to save lives and help the injured. For many diseases, although there is no way to always grab the sickle that the god of death slashed at the patient, but strive to be ashamed. For unexpected situations that are really unpredictable, hospitals and individual doctors should be prepared at all times, and we are facing a living life that cannot be lost.
For inspectors, in the face of many diseases, we should not just be silent testing machines, issuing cold test data. When for more abnormal test results, we should also communicate with clinicians in time to remind them to be vigilant, and it is not only clinicians who are racing against death, but also our inspectors who need to compete for every second.
Source: Inspection time
Edited by: Yeah Reviewer: Xiao Ran