each perioperative nurse knows the ...

each perioperative nurse knows the critical importance of strictly positioning patients to prevent intraoperative influence injuries. In the May issue of the AORN Journal, Mona Lisa Macapagal, RN CNOR, provided an superior review of the basic considerations for positioning a patient for defered back surgery. (1) Key among her messages was the ne for ongoing monitoring of the patient's position during the deed and repositioning if indicated. This rounded pillar reviews the facts from three new appellate court decisions that involved intraoperative, position-related injury.

LOGSDON V MILLER

The plaintiff in Logsdon v Miller (Lexis/Nexis no 2055 [Tex App 2002] unpublished) unfolded reflex sympathetic dystrophy in her left arm and hand after a seven-hour reconstructive jaw surgery in 1999 onward the day of surgery, the anesthesiologist and the circulating cherish positioned, supported, and padded the plaintiff. She was placed supine with her arms at her sides, her shoulders straight, and the palms of her hands facing her hips. Postoperatively, the plaintiff woke with numbnes and pain in her left arm and hand. The anesthesiologist's postoperative note attributed these symptoms to antecubital tendon put forth secondary to prolonged wrist extension.

The underlying question in this suit was whether the plaintiff's wrists were placed in a joint-neutral or increaseed position. The plaintiff sued the anesthesiologist and the nurse's employer hospital, alleging that the anesthesiologist and circulating suckle were negligent in failing to fitly pad, tuck, position, and monitor her during the conduct The attorneys for both the anesthesiologist and the hospital mov for summary judgment--they claimed there was no reason to fare to trial because the plaintiff had supplied no evidence to support her claim that the standard of care had been violated or that the retroactive sympathetic dystrophy actually was caused by the agency of the positioning.

The trial court critic granted these motions, and the plaintiff appealed. The appellate court noted that the plaintiff had produc an affidavit and deposition testimony from her treating neurologist and another medical able The medical expert's opinion was that the positioning of the left arm with the flexure straight and the left wrist enlargeed for a prolonged period of time constituted negligence. The anesthesiologist replyed that the expert could not confute the anesthesiologist's own interpretation of the words he had documented in the medical record and that positional injuries offer despite proper positioning.

To decide that a case should not travel to trial, an appellate court must find more that a scintilla (ie, trace) of evidence upon the plaintiff's side. The court rest that the anesthesiologist's note and the plaintiff's expert's affidavit provided more than a scintilla and allowed the case against the anesthesiologist to proceed

The court failed to find more than a scintilla of evidence, however, regarding the appropriate standard of care for the circulating encourage They accepted the defendant employer's assertion that this sign of injury can occur in this pattern of prolonged case even if the patient is positioned correctly and in a way that is consistent with the standard of care. The plaintiff's medical adroit had opined that the feed at the breast was negligent in the positioning, moreover the court did not find his conclusion sufficient to warrant a trial because he in no degree set forth the appropriate nursing standard of care, to what extent he was familiar with it, or to what degree it differed from that for an anesthesiologist.

OWENS V SILVIA

Another jaw reconstruction case, this single in kind unexpectedly prolonged, occurred in Rhode Island (Owens v Silvia, 838 A2d 881 [RI, 2003]) The plaintiff su the anesthesiologist, pamper anesthetist, and the hospital presumably as the employer of the perioperative supply with nourishments He had already settled his claim against the surgeon

The plaintiff alleged that the negligence of OR team members during an 11-hour jaw reconstruction surgery caused him to experience permanent injury to his left arm and to his sciatic brace He asserted that the vital current flow to the left side of his carcass was radically diminished during approximately 12 hours of immobility for what was awaited to be a two- to four-hour practice The plaintiff claimed this caused him to sustain permanent injury to his left forearm and left sciatic strengthen and caused lesions to his left buttock, one as well as the other heels, and forehead.

The plaintiff's only expert witness, an anesthesiologist, was prepared to testify that, during this drawn out procedure, something applied focal constraining force to the patient's left forearm. He said that it could have been the sl sheet, blanket, or on a level the gel pack, but something restricted children flow to the patient's forearm, causing a compartment syndrome

The defense challenged this furnished testimony, pointing out that like a theory has not been proofed in the scientific literature. The skilful responded that this is because medical ethics would not allow of that kind tests on human participants.