This case involves a six-year-old female who was admitted to the hospital for seizures. While in the hospital, the girl experienced a grand mal seizure, which caused her to aspirate. Two days later, the emergency medicine team released her and stated that she was in good health. Three days later, she was brought back to the hospital with fever, cough, and chest pain. An x-ray revealed that she developed pneumonia with evidence that it had been there for days. She was initiated on antibiotics but her symptoms persisted. Over the next twenty-four hours, her condition rapidly declined. Her oxygen saturation quickly fell to 70% and she slipped in and out of consciousness. She then became unresponsive requiring resuscitation. After two weeks of hospitalization, the girl was discharged. Once she returned to school, her teachers began to notice significant learning difficulties. She was referred to a neurologist, who determined that she probably sustained brain damage from lack of oxygenation to the brain. Her physical education teacher also reported that the girl seemed uncoordinated since returning to school. Before her hospitalization, she was regarded as one of the better athletes in her class. During her childhood, she required tutoring, speech pathology, occupation therapy, mental health and physical therapy. She never fully regained functioning.
Question(s) For Expert Witness
- Did the medical team in this case practice the standard of care when treating this girl, and, If not, what could have been done to prevent the result of this case?
Expert Witness Response
The medical team neglected the fact that seizures can predispose a patient to aspiration pneumonia. Any condition that impairs level of consciousness can cause a person to aspirate oropharyngeal or gastric contents. If these contents travel up into the lungs, permanent and serious damage can occur. This patient developed aspiration pneumonia which was not diagnosed during hospitalization. This girl should have had an x-ray to rule this possibility out. Contents in the lung can cause significant damage including acute respiratory distress syndrome. Rapid oxygen desaturation was observed in this patient causing loss of consciousness and decreased oxygen delivery to the brain. As a result, she developed significant brain injuries manifesting as mental and physical dysfunction. Had the diagnosis of aspiration pneumonia been made during the first hospitalization, treatment could have been initiated earlier. Therefore, the girl probably would not have developed significant lung damage and physical decline.