An infant with numerous congenital defects, including hypospadia and developed ventricular septal defect, rapidly developed epilepsy and compartment syndrome during an operation. Expertise in both heart failure and compartment syndrome was needed to comment on the case, which was instigated by a hospital’s attempts to operate and remedy some of the infant’s congenital defects. Instead of alleviating them, however, the infant developed metabolic acidosis with cool extremities and poor pulses directly after the procedure. When the hospital attempted to counter his condition with attempts to intubate and chest compressions, he became bradycardic and lost palpable pulses; by the time the patient was intubated, he was suffering from multiple metabolic abnormalities, including acute kidney injury and a shocked liver. He quickly developed seizures, and the hospital’s attempts to place a new arterial line in his right arm instead developed ischemia and required fasciotomies of the forearm and hand. Overall a complex case stemming from congenital defects, the competency of the hospital in administering care was questioned in trial.
Question(s) For Expert Witness
- 1. Do you routinely care for patients like the one described in this case?
- 2. What measures should be taken when ischemia of the digits is noted after arterial line placement?
Expert Witness Response E-109077
Our hospital’s Pediatric Intensive Care unit regularly cares for children with similar congenital conditions. I would need more information about the operation and ensuing efforts to alleviate the infant’s condition in order to comment on the standard of care in this case, but I have been practicing pediatric critical care for about twenty years. I am also active in research and publishing related to the care of critically ill and injured children.