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SIERRA VISTA HERALD (Arizona) 22 July 04 Therapist explains treatment snake bite victim received (Michael Sullivan)
Bisbee: Defense witnesses who were called to the stand Wednesday morning in a $7 million malpractice suit brought against Sierra Vista Regional Health Center described and analyzed what happened in the hospital's emergency room on Oct. 18, 2001, in treating a rattlesnake bite case that led to the suit.
Respiratory therapist Brandie Webb led off testimony Wednesday, detailing her role in treating Christopher Mabbutt of Sierra Vista. Mabbutt was bitten on the right index finger and eventually suffered severe brain damage, which has left him incapacitated. The complaint in the case charges that Mabbutt was not properly treated.
Webb testified that she and another respiratory therapist, Bill Christensen, worked on ventilating Mabbutt when he had difficulty breathing. In her view, Mabbutt "seemed adequately ventilated" by the oxygen mask, or "bag," that was being used. His gums were pink and his chest rose and fell, she said.
But Mabbutt continued to struggle for breath. Webb said Dr. Richard Wagner, named in the suit, was having difficulty working a tube down into Mabbutt's airway because of swelling in that area. Such swelling is typical in rattlesnake bite cases, earlier testimony had established. Wagner made four futile attempts to pass a tube down Mabbutt's throat before making an incision in the throat to insert a tube into the airway. Approximately 20 minutes passed from when she arrived in the emergency room to when the tube was placed, she said.
Mabbutt eventually went into cardiac arrest, reducing the flow of blood to his brain.
Attorney Randall A. Hinsch, cross-examining Webb, pressed her on the hospital's procedures, or "code," in calling for additional help in the emergency room.
Following Hinsch's questioning, defense attorney David E. Hill elicited testimony from Webb that there seemed to be enough staff in the emergency room at the time.
"Codes are rarely called because the people who need to be there are there," she said.
Christensen testified last week that Mabbutt was in "respiratory distress" when he arrived in the emergency room and was "extremely agitated." Christensen administered the drug epinephrine through a respiratory mask to treat what was diagnosed as a severe anaphylactic reaction.
Dr. Ron Walls, chief of emergency medicine with Boston's Brigham and Women's Hospital, followed Webb to the stand and described the nature of the cardiac arrest that Mabbutt experienced.
Approximately seven minutes passed when Mabbutt's heart was not pumping blood, emergency room monitoring records show. Walls said Mabbutt would not have survived without the ventilation being administered.
"He was being adequately oxygenated," Walls said.
The respiratory therapists' evaluation of Mabbutt's color and chest movement were accurate, he added, despite some contradictory evidence from monitoring equipment.
The monitoring evidence cannot be relied upon, Walls said. "The monitors are not foolproof."
Certain patient characteristics can make the monitors fail to record accurately, he said. The medical staff must rely on their evaluations of the patient's condition, not on monitors, he asserted.
The trial, which began on July 15 in Cochise County Superior Court before Division 2 Judge Stephen Desens, is expected to go to the jury on Friday.
Therapist explains treatment snake bite victim received

That this case involves one of the few doctors who regularly and competently treats envenomations. Dr. Richard Wagner is not one of the butchers who will cut first and ask questions later. He actually is one of the best clnicians in the US treating envenomations and one who's advice/medical care I would accept almost without question. This case appears from the reports to have just been a tragic result of envenomation, not medical incompetence.

Cheers
Bryan
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Dr. Bryan Grieg Fry
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Australian Venom Research Unit,
University of Melbourne
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Population and Evolutionary Genetics Unit,
Museum Victoria
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http://www.venomdoc.com