Anesthesiology expert witness advises on fatally misplaced trachea tube

    Anesthesiology expert witness - trachea tubeAn anesthesiology expert witness advises on a case involving the decedent, who was in his 60s, was seen in the emergency room for severe abdominal pain. He was evaluated and diagnosed with an incarcerated ventral hernia. He had a significant history of COPD. Late at night, he was taken to the operating room for emergency repair of the hernia and release of a small bowel obstruction. After administration of anesthesia, the anesthesiologist performed a rapid-sequence intubation. After surgery, decedent was taken to the recovery room, where he was intubated and ventilated. It was determined that the endotracheal tube should be moved and it was withdrawn several centimeters. Soon after this, significant subcutaneous air was noted, and it was discovered that he had a large tracheal injury. This injury proved fatal.

    Decedent’s survivor filed a negligence action against the hospital and anesthesiologist.

    Question(s) For Expert Witness

    • 1. Was the standard of care breached?
    • 2. What evidence is there of a breach?

    Expert Witness Response

    I have reviewed the medical file of decedent, the coroner’s report and a patient log/diary constructed by the decedent’s family. In this case, to a reasonable degree of medical probability, the defendant fell beneath the accepted standard of care. Although airway injury from endotracheal intubation is a known complication, such injury is usually more proximal and involves more vulnerable structure than the trachea itself. The location and size of this injury — 1cm x 3 cm distal trachea extending into the right mainstern bronchus — suggest management below the standard of care. Moreover, it is my medical opinion to a reasonable degree that the aforesaid breach of the standard of care by defendant caused this injury that ultimately lead to the patient’s death following several weeks of mechanical ventilation and ICU care.

    The expert is board-certified in internal medicine and anesthesiology and is chief of anesthesiology at a hospital. He also is a professor of anesthesiology.

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