A 47 year-old man with Down's Syndrome had been hospitalized for a possible pulmonary embolism. Part of his treatment involved the use of anti-coagulants, including Coumadin and Heparin. A nurse accidentally increased the patient's Heparin dose, when it should have been temporarily suspended, resulting in bleeding complications including hematuria and a nose bleed. In addition, within 24 hours the man also began experiencing neurological symptoms, including leg weakness and back pain. Another nurse was alerted to these problems as well as an attending pulmonologist, who consulted with a neurologist. Unfortunately, the neurologist never came in to evaluate the patient, and, tests to rule out a spinal problem as a cause of the back pain and leg weakness were not ordered. In addition, the pulmonologist failed to make a note in the chart documenting the back pain and leg weakness. The consulting neurologist advised his partner to see the patient the next day for morning rounds, however, she did not do so claiming there was not a note in the chart indicating there was any neurological problem. The patient's leg weakness progressed, and, finally, at the insistence of the family another neurologist evaluated the patient the next day and noted that he had paraplegia. An emergency MRI diagnosed that the paraplegia was caused by a bleed in the thoracic spine known as an epidural hematoma. Emergency surgery was done, but, regrettably, it was too late to reverse the man's permanent paraplegia.
Had an MRI been ordered when the patient's symptoms began, neurologic surgery could have been performed to evacuate the hematoma before it caused permanent damage to the spinal cord. Typically, for the best chances of success, such surgery ought to be performed within 24 hours from the onset of symptoms. Similarly, the epidural hematoma may have never occurred had a nurse not accidentally increased the dose of the patient's Heparin. Blume Donnelly partner, Michael B. Zerres, handled the matter on behalf of the patient and his family.
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