domingo, 6 de marzo de 2016

Home | AHRQ Patient Safety Network

Home | AHRQ Patient Safety Network



PSNet: Patient Safety Network



WebM&M Cases

  • SPOTLIGHT CASE
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  • CME/CEU
Commentary by Tara Kirkpatrick, MD, and Chad LaGrange, MD
Despite mechanical problems with the robotic arms during a robotic-assisted prostatectomy, the surgeon continued using the technology and completed the operation. Following the procedure, the patient developed serious bleeding requiring multiple blood transfusions, several additional surgeries, and a prolonged hospital stay.
Commentary by Vineet Chopra, MD, MSc
Hospitalized with poorly controlled diabetes, a man had a peripherally inserted central catheter (PICC) placed for intravenous pain medications, intravenous fluids, and parenteral nutrition. The next day, the patient complained of headache, unilateral vision loss, and left-sided tingling and numbness. Misplacement of the PICC in a left-sided superior vena cava had led to embolic strokes.
Commentary by Christine M. Gillis, PharmD; Jeremy R. Degrado, PharmD; and Kevin E. Anger, PharmD
Presenting with a cough and shortness of breath, a woman with end-stage renal disease was admitted to the medical floor after undergoing hemodialysis. She was given allergy and sleep medications at her home dosages. The next morning the patient was extremely drowsy and unresponsive to painful stimuli. A "Code Stroke" was called.

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