Publication In Good Faith For Redress Of Wrong
This Site Is Dedicated To Malpractice Prevention
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The Arlene Berry Case
"Truth Cannot Live on a Diet of Secrets |
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Health is an issue that affects everyone, one that cuts across class, race, and sex lines. Our health care organizing will have at least two goals; (1) building those kinds or struggles which more people to challenge the particular abuses of local institutions and providers, and (2) giving people a sense of the kind of quality of care they have a right to, and should demand, from this, or any other system. |
There's a trend in the UK towards prosecuting doctors for manslaughter. Some are even ending up in jail. So I think that the message I¡¯m giving you is that if Canadian doctors and nurses do something really serious or show a blatant disregard for a patient¡¯s welfare, then such person(s) can and should be threatened, charged and prosecuted with criminal charges.|||||||||||||||||||||||||
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This report represents more than 4000 man hours time expended in research and private investigation into what can only be described as one of the most hideous crimes of the century perpetrated by doctors and nurses in Northeastern Ontario in order to save face. I have sketched the general nature of the evidence which I will present. It bespeaks of medical blunders and medical stupidity and the taking of an innocent life (the end result is a 41 year old mother of two children gone) due to medical stupidity and despicable hospital cost-containment policies. That we are living in a disposable society, without values, there is not a shadow of a doubt. Such are crimes as in this case ranging from criminal negligence to outright fraud and fraudulent concealment to corporate (hospital) criminal cover-up, criminal conspiracy and government acquiescence, obstruction of justice and collusion utilizing half truths, bald falsehoods and all the cloak and dagger techniques known to spies to obfuscate the truth; paradoxically, we have a rise to prominence of a powerful minority of misguided zealots opposed to truth and justice. In terms of a conspiracy and coverup, silence doesn't only imply concealment, it also infers guilt.
There are many individuals whose otherwise happy and productive life has been destroyed or doomed by
hidious crimes perpetrated by medical professionals resulting in
iatrogenic injury or debilitating and/or fatal disease and unnecessary death due to
homicidal criminal negligence or outright medical stupidity. Pressing action for criminal accountability is urgently needed in preventing such events from occuring in future. This present climate of impunity in Ontario courts has only encouraged bad doctors to flout the Criminal Code. The Federal Court of Canada may offer some relief, since federal authority for criminal law and procedure ensures fair and consistent treatment of criminal behaviour across the country. |
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A PHYSICIAN CANNOT ESCAPE the essential principle: Primum non nocere "First Do No Harm". Whenever you grant immunity from fault you breed irresponsibility. No policy change or audit will ever bring back this young mom. However, by making the doctors and nurses criminally accountable, this investigator hopes to ensure that the likelihood of a similar recurrence will not happen again. This has nothing to do with a drug reaction per se, but rather it has everything to do with ignoring outcome to near fatal conclusions, and medical homicide. My mission is to ultimately prove criminal homicide, and criminal negligence, including corporate criminal liability, together with the facts of this case, with scientific precision if need be, and to ultimately utilize the criminal justice system to the fullest to punish all those involved in Arlene Berry's death and subsequent cover-up. Let it be known that I am NOT interested in blood money. What I want is "JUSTICE" for Arlene Berry, nothing more, nothing less. |
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The information contained herein is based on evidence
based research, computer assisted. Evidence-based medicine is a process of systematically finding, appraising, and using research findings as the basis for clinical decisions based on the formulation of relevant question concerning a patient's problem. Compare: PROBLEM SOLVING
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These are the facts: |
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In December of 1999, Arlene Berry was sent to
Timmins & District Hospital in Timmins, Ontario where
she was diagnosed, according to her physician, "with carcinoma of the
left main bronchus with residual cancer of the aorta due to a complete
collapse of the left lung". Her family MD,
Dr.
Edward Henry 11
had misdiagnosed her in that he had been treating her
assumptively for what
he termed a "suspected
bronchitis".
It took another doctor to read her X-ray chart
and to order more appropriate testing before anything was done. By the end of April of 2000 Arlene Berry had completed a
5 week postoperative course of radiation therapy. In light
of this treatment, her condition was seen to be stable.
Postoperative testing results done on March 16th in Timmins
were seen to be very encouraging and from that treatment and testing it
seems clear that Arlene Berry had every reason to expect a partial
remission, or stable condition. On May 23rd of 2000, and on the days before, Arlene Berry presented to the Kirkland and District Hospital with symptoms of nausea, vomiting, sedation, dizziness, headache, and mild diffuse weakness. CAVEAT: DRUG INDUCED MYOPATHY - The onset of clinical manifestations of drug-induced myopathy usually develops insidiously and can occur from days to months after exposure to the causative agent. Commonly, patients present with nonspecific complaints of progressive, generalized muscle weakness (diffuse weakness) muscle pain (myalgia), or fatigue. Proximal or diffuse muscle weakness of the arms and legs is the hallmark symptom in Toxic Myopathies and infections in hypokalemic myopathies. Compare Muscle wasting and diffuse weakness in combined effects of sepsis and multiple organ failure, and such as seen in encephalitis and meningitis. The progressive course of this patient's headache, as well as nausea and vomiting had suggested the presence of increased intracranial pressure. NO toxicology screening was done. In addition to the radiation therapy consisting of nuclear medicine Arlene Berry had also been prescribed and given MS Contin 22 , including STATEX 23 for pain management, both of which are morphine with constipating properties. 24 Because morphine may increase biliary-tract 25 pressure, some patients with biliary colic 26 for example, may experience worsening rather than relief of pain. Morphine has many side effects 30. The most dangerous is respiratory depression 31. In frail patients, as the respiratory rate decreases, the patient becomes increasingly sedated 32. See: Morphine Risk Groups 33. Compare: Opioid overdose 34. See: Drug overdose Compare: Sedation Compare: Nuclear Medicine cases by study type Compare: Intra-abdominal
abscess,
27 ,Colonic
obstruction
and Opiod
dependance 29
.
A-5 of the record documents the patient's presenting complaint as "headaches accompanied by severe stomache pain" that is consistent with the "abdominal pain ongoing for 2 weeks" for which she was prescribed "antibiotics" 35. Compare: Antibiotic Classes.The RN who saw her noted that she had been takingMS Contin 22 (morphine) for her pain and also that she had "stopped taking the morphine", noting also her past medical history consisting of "taking radiation". There is nothing on the record to suggest that this patient had been examined for her stomach pain, either for constipation 36 or possible bowel blockage 37 associated with the morphine. People with bowel obstructions may repeatedly vomit yellow or green colored bile, and may have a distended (swollen, uncomfortable) abdomen. Stomach pain is also a prominent finding associated with dehydration 38, including constipation. Most sickness and health problems start from a toxic colon. Toxic megacolon is a life-threatening complication of other intestinal conditions, characterized by a very dilated colon, abdominal distention, and sometimes fever, abdominal pain, or shock. Colon cleansing usually eliminates the underlying causes of stomach pain. Conditions listing complications: Constipation:
According to family, Arlene Berry had stopped taking the
morphine at home due to "increasing severity of constipation requiring
extra laxative and tap water douches to assist with stool evacuation" (straining to evacuate the bowel can increase intracranial pressure),
and also due to
dizziness,
40 marked by a sense of uneasiness progressing to
unsteadiness or "lack of motor coordination"
41.
Ataxia
42
symptoms are similar to alcohol intoxication
43 and
include staggering ataxia/gait
44 . Compare C I P R O Information and Side Effects. There is also evidence of "inappropriate behaviour" 45 as witnessed by family and friends.
From the records it is also clear that Arlene Berry had a history of
"opiate" use, including
Acetaminophen
46
(Tylenol), among other medications as evidenced by her
Rx list
47 . There
is nothing on the record to suggest that the patient was ever tested or
examined for possible side effects
48
associated with the MORPHINE
49 she had
been prescribed, such as
opioid-induced nausea and vomiting
50 , or
for possible other side effects such as associated with the
withdrawal from opiates. Respiratory depression is also a hallmark of opioid toxicity and is the result of CNS depression.
51.
Compare
Morphine Side Effects.
52. Many
drugs and medications produce
withdrawal symptoms Following her postoperative course of radiation therapy,
Arlene Berry had remained quite well until about one week prior to her
admission to the Kirkland and District Hospital on the 23rd of May 2000.
Over that week she had developed headaches
53 that at times had become increasingly severe. A severe
headache is a common but not invariable accompaniment of
intracranial causes of nausea
54. and
vomiting.
When a Headache Isn't Just a Headache Compare Acute Hepatic Failure (May not be associated with fever. May aggravate encephalopathy). See also Infective endocarditis Compare: Urethritis According to the record at
A-6 she returned to the ED (Emergency Department) on May
23rd of 2000 with "the very same complaints". On examination
the physician who saw her documented positive "bowel sounds"
57 consistent with physical findings of
hyperactive bowel
sounds
58 ,
(... bowel sounds often indicates constipation), a sign of abdominal distention
59 which
can rapidly progress to
intestinal obstruction
60 in
which bowel sounds become hypoactive
61 due
to paralytic
Ileus
62.
Compare
Abdominal symptoms (nausea, abdominal pain or distention)
associated with Heart
Failure.
Compare iatrogenic, toxic and metabolic neuropathies.
Chronic
Inflammatory Neuropathies What also appears to be a referral at A-6 of the medical record, a chart copy from the admitting physician directed to the attention of the attending physician documents what I take to be a provisional diagnosis 81 of "vomiting". Submit that vomiting is NOT a diagnosis but rather a symptom 82 of many causes. See: Nausea and vomiting Further, a question appears to have been raised (but also ignored) with respect to possible metastatic 83 cancer of the brain, leaving the etiology 84 of the vomiting and the stomach pain left undetermined for the attention of the patient's family MD, namely, Dr. Jordan. Submit that stomach pain concurrent with nausea and vomiting points to the "abdomen"85 as the source of the problem. There are NO records to suggest that the ED physician had ever bothered to take the time to perform a Complete Physical 86 or a Neurological Examination 87 of this oncology 88 patient. Compare: Oncologic Emergencies 89. See MEDICAL ONCOLOGY: A COMPREHENSIVE REVIEW.
From the record it is clear that NO diagnosis
90 or
differential diagnosis
91 was
made at that time, or at all, as evidenced by the record at
A-3. From the same record it is also clear that nothing was
entered because nothing was done. A reasonable physician would
have correctly diagnosed the patient's condition by doing what Dr. Jordan and all those who attended to Arlene Berry failed to do
in his absence. Submit that clinical features of brain abscesses are associated with a progressively severe headache 95 in 70%-90% of patients with brain abscesses. Epidural Abscesses are usually mixed infections that include anaerobes micro-aerophilic strep. and Staph aureus. An epidural abscess is caused by infection in the area between the bones of the skull or spine, and the outer meninges (the membranes covering the brain and spinal cord). An epidural abscess is a medical emergency. See also MedlinePlus Medical Encyclopedia: The flu Patients with limb ischemia 93 present with the classic signs of pulselessness, pallor, and paralysis due to SHOCK = cardiovascular collapse 96. Indeed, these are also signs and symptoms of a stroke 97, i.e. ischemic stroke 98 or thrombotic stroke 99, such as caused from interruption of blood flow to the brain by a blood clot 100. An ischemic 101 (or clot) stroke occurs when a blood clot obstructs flow of blood to a portion of the brain due to inadequate blood flow. 102
In meningitis the disease can
block blood vessels in the brain, causing stroke and permanent brain damage.
Ischemic stroke is a life- threatening event in which part of the
brain does not receive oxygen, usually due to a blood clot.
Compare also
Transient ischemic attack
103 (TIA) such as caused by an interruption of blood flow
to brain cells. The emergency record from the hospital dated May 22nd of
2000, seen at
OP-54 documents a recent history of hematuria
104 (blood
in urine ) for three days and a prescription for
Ciprofloxacin
105 (Cipro),
for treatment of Urinary Tract Infection
106.
Cipro is an antibiotic indicated in the treatment of a
variety of infections, including the "flu". Notably also,
the same drug is given when superimposed
bacterial
infection
107from
Radiation Toxicity
108 such as
ulcerative
colitis, for example, is present. Bacteremia
in febrile patients. A clinical model for diagnosis.
The True Story of Cipro
MedlinePlus Drug Information: Ciprofloxacin
Compare Radiation toxicity:
See:
Acute radiation syndrome.
Clinical Radiation Toxicity
eMedicine - Intestinal Radiation Injury : Article by Rajeev
...
Protocols - Radiation Injuries Ciprofloxacin can potentiate existing
renal insufficiency
109 and
may enhance concomitant
drug toxicity (drug toxicity can mimic or be superimposed on rejection or infection) with enhanced potential for
Ototoxicity110.
Compare: gait/ataxia in
ototoxicity
111 ,
which can effect ballance, with damage to balance functions.
See: Gait
ataxia in ototoxicity.
Liver failure associated with ciprofloxacin was reported in the
Lancet in 1994
112.
Ciprofloxacin has been implicated in several cases of acute
renal failure
113 and is the most established fluoroquinolone
The same record documents "blood when voiding"
116, and
also that she had been given "antibiotics for 1 week", including
the "1 given now". The same record also documents "large blood
trace
leukocytes"
117, what
are the White Blood Cells
118. The
blood contains
erythrocytes (red blood cells), leukocytes (white blood cells),
platelets and
blood plasma. The number, type and age of the white blood
corpuscles reflect the state of the body's immune system and ability to
combat infection, or
infectious disease. Thus in the presence of infection, the
healthy body pours millions of white cells into the bloodstream. The normal white blood cell (WBC) count is 5,000 to
10,000 per microliter depending on the severity of infection.
An elevated WBC count may also contain an increased number of immature forms of
white cells called "bands"
119.
eMedicine - Hyperammonemia : Article by Karl S Roth, MD
Inflammatory diseases of the brain
128
include abscess
129,
meningitis or cerebrospinal meningitis 130,
encephalitis
131 and
vasculitis132.
Compare: ammonia in the development of
portal systemic encephalopathy
133, a
metabolic encephalopathy
134
that occurs when the brain is exposed to toxic metabolites of
gut origin
135 that reach the brain because of inadequate hepatic
clearance
136.
Clinically, many conditions producing increased intracranial pressure or progressive neurologic deficits mimic brain tumors. These include subdural hematomas, brain abscesses,hydrocephalus, benign intracranial hypertension, progressive multifocal leukoencephalopathy, multiple sclerosis, vascular malformations, cerebral infarctions, Alzheimer's disease, and some congenital anomalies. Many of these conditions have characteristic radiologic appearances that enable them to be differentiated from brain tumors. However, some of them brain abscesses and certain inflammatory lesions, demyelinating disease, hamartomas, and congenital anomalies cannot be distinguished from brain tumors on the basis of their radiologic appearances alone, and a definite diagnosis often requires biopsy. Even when the imaging characteristics of a lesion are very suggestive of a tumor,a biopsy is usually indicated to obtain tissue for precise histologic diagnosis and grading of the tumor since these factors will have an important bearing on treatment.
FIRSTConsult - Brain tumors, benign - Medical Condition
File
THE MERCK MANUAL, Sec. 14, Ch. 176, CNS Infections Organic brain syndromes (as the term is used historically)
may apply to the complications of severe head trauma, drug toxicity,
brain infection, and dozens of other causes
Ask the Expert Common precipitants of
hyperammonemia
140 , an
elevated level of
ammonia in the blood manifested by lethargy
141 and
worsening mental status142
,
renal failure (when the
kidneys fail to function properly)
143 ,
GI bleeding
144,
infection and constipation. The same record documents "Here 1 week ago for UTI.
Last period on 6th of May". Onset of her menstrual period is
closely related to her illness in which symptoms result from production of
toxin suggestive of staphylococcus
151, which may then wash backwards up through the vagina,
uterus and fallopian tubes, or similar mechanism to be absorbed from
the peritoneal lining
inside
the abdomen. Case reports cited primarily in women who are having periods
in which a blood-soaked tampon
152 may
provide an excellent breeding ground for the staph
aureus bacteria
153
present in the vagina, a significant cause of female urinary tract infections. Interestingly, the urinary tract is one of the few
sites at which
coagulase-negative staphylococci
157 are
more usual pathogens
158 than
s. aureus.159
S. aureus infection is unlikely to occur in patients with a normal
urinary tract, except in staphylococcal septicaemia
160 blood
poisoning, when the organism can often be recovered from the urine
161,
presumably the result of microabscesses
162 in
the kidney. In TSS, acute renal failure, abnormal liver function and refractory hypotension follow. COMPARE: Staphylococcal Infections
163 in
an afebrile
164 patient with
Dehydration. Up to fifty percent of patients with brain
abscesses 165
may present with an afebrile history. Arlene Berry had an
afebrile history as evidenced by the record. Toxic shock syndrome presents as a flu-like illness with or without fever, vomiting, diarrhea, constipation or toxic megacolon, general malaise, and muscle weakness.
When TSS is treated appropriately, full recovery is the rule, although some patients may have persistent neuropsychologic dysfunction (eg, memory loss, lack of concentration), mild renal failure, late-onset rash, or onset of new allergies.
Compare also Proteus spp,
170 a
gram-negative motile
171,
aerobic rod shaped bacilli
172,
urease positive
173,
characteristic swarming part of the normal flora
174 of the
GI tract
175 A leukocyte response suggests leukocyte recruitment which may point to the likely offending organism as being a Gram-negative pathogen 176 Leukocyte recruitment 177 is the hallmark of the inflamatory response 178. Compare - The phases of inflammation According to my research, a negative urine test 179 can suggest the presence of unusual bacteria or viruses causing symptoms of UTI. Compare Pseudomonas aeruginosa 180, a gram-negative opportunistic pathogen 181 that frequently causes hospital-acquired infections producing symptoms of UTI, which can easily spread from patient to patient, causing outbreaks of infection with important implications for healthcare facilities. Similarly, it can also be passed on by a patient or infected healthcare worker to outsiders, such as family and friends of a patient, where it can further be transmitted to others within the community, placing the entire community at risk for infection and further transmission, such as seen in assymptomatic 182 carriers. Hence, the motive, in addition to fraud, for a hospital cover-up. The major offender in the sterile bladder environment is the indwelling urinary catheter 183, but can also be test or procedure related. For example, coagulase-negative staphylococcus (S. epidermidis 184, due to presence of the germ "coagulase negative staph". This is a common skin germ but can be pathologic 185 (cause infections) in the body, as it appears to have done here. The same healthcare provider (whose signature is illegible) also made a notation with respect to the "flu" which had then been directed to the attention of the patient's "family MD", Dr. Jordan. The healthcare provider who saw her made a provisional diagnosis of UTI. The test result from that diagnosis however, what I assume to have been a urology test, or a blood culture 186 test, evidenced at OP-55 of the Outpatient Record later returned a finding of "NO Growth" 187. Compare: Urinalysis. The same record documents "SEPTRA DS 188 GIVEN BEFORE & CIPRO GIVEN AFTER". What is Blood culture ? Compare: Urine culture The commonest isolate from cultures nowadays is Coagulase Negative Staphylococci (CNS) mainly due to contamination of the blood after being taken for culture . Reference: nosocomial 188 infection. Compare SEPSIS 189.
Major contributors to nosocomial infections include the
emergence of antibiotic-resistant bacteria,
poor hygiene practices by
healthcare providers, incompetent staffing, substandard practices and
apathy on the part of healthcare providers. Nosocomial, derived from
Latin, means "hospital-acquired"
190. The
term is used to shield hospitals from the "embarrassment" of
germ-related deaths and injuries, injuries leading to death
exacerbated by hospital cutbacks and carelessness by doctors and
nurses. According to the hospital outpatient record at
OP-54, the patient's recent head CT scan showed "NO
METASTASIS"
201, and her mediastinoscopy, samples of the cells and
lymph nodes 202
that had also been done on the same date were found to be "NEGATIVE".
Notably, mediastinoscopy is also used to stage
203
lung cancer. From that record it seems clear that NO clinically
detectable metastasis were found. The purpose of the mediastinoscopy
is to show whether cancer or tumors have spread to the mediastinal nodes.
Problems with damage to internal organs, infection, and bleeding are
possible and can also be detected from the mediastinoscopy. What the
family had found to be peculiar however, was the dramatic voice change
204
following the mediastinoscopy that was done in Timmins on March 16th of
2000, what I take to be iatrogenic vocal fold
paresis However, Arlene had began to regain her voice in the days prior to
her death . The same record documents a history of
Tylenol and Aspirin, including the notation "daughter states takes a lot"
- suggests use of that can break the gastric barrier
211 and
damage the gastric mucosa
212, ie, aspirin, NSAID's
213
(non-steroidal anti-inflammatory drugs). Compare Salicylate Toxicity
214.
Later signs of aspirin poisoning
227, or
signs of more significant poisoning, include drowsiness or
confusion, bizarre behavior, unsteady walking, and
coma
228.
In this case all of these signs and symptoms were present. Hepatotoxicity
231 can
result from acute overdoses or from chronic use (i.e., several
months of daily administration). Tylenol side effects232
include: light headedness, dizziness, drowsiness, and
slurred speech, the very same as that of Arlene Berry. Compare:
Drug overdose Acetaminophen, while generally safe for short-term
use, can cause problems with long-term administration. These problems
include liver and kidney damage
240 and
gastrointestinal bleeding
241.
Acetaminophen is contraindicated in liver disease
242 in
which slurred speech may be associated. Compare: Vertigo-associated
242
disorders in which slurred speach
243
associated with infection is a prominant finding. Compare
analgesic 244
medicines associated with kidney failure.
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What I take to be a continuation of
A-21 of the same record seen at A-23
documents a "slurred" speech as
evidenced by a √ in the upper left corner, also sign of iatrogenic drug
induced intoxication in which dysarthria
266is
a prominant finding in the
setting of Portal-Systemic Encephalopathy (PSE)
267. In typical PSE there are no fixed motor or sensory neurologic findings, which is consistent with the metabolic and reversible nature of this disorder. Initially (before overt changes in mental status) there may be relative hypothermia and hyperventilation, both apparently of central nervous system (CNS) origin. The deep tendon reflexes are initially hyperactive. There may be fleeting upgoing plantar responses on either side, but no lasting evidence of altered long tract motor pathways.
Further, dizziness, drowsiness,
lethargy, ataxia, have all been cited with adverse events,
including slurred speech, syncope sup>
267, GI
bleeding, constipation, nausea, vomiting,
urinary
incontinence , and urinary retention. These are also
findings associated with opiod and acetaminophen toxicity in
Hepatic Failure
268. Compare Syncope (The cause of loss of consciousness in syncope is global cerebral hypoperfusion - blood pressure drops, so the entire brain becomes ischemic for a brief time. Syncope is not due to primary brain disease, but if the hypoperfusion is prolonged for more than two minutes irreversible brain damage begins to occur). See
: Hepatitis, drug-induced
Further findings suggest that constipation actually gives rise to a
process of self-poisoning
269.
Thus,
auto-intoxication
270 is the
process whereby the body literally poisons itself by maintaining a
cesspool of decaying matter in its colon. During
fasting, (tantamount to anorexia) the
concentration of toxins expunged from the body and appearing in
the blood can increase ten times above normal concentrations. The
released toxins can either exacerbate the symptoms being
treated or create their own symptoms such as headaches,
body ache, joint pain, dizziness, sweating, general malaise, sore
throat, nausea and/or flu-like
271
symptoms. Compare hypoperfusion in CNS infections
The record at OP-54
dated May 22nd of 2000 documents a "haggard
appearance" including "large blood trace leukocytes"
272.
Notably also, leukocytes
273 (WBC's)
are elevated with dehydration, hyperviscosity
274
secondary to
dehydration
275, and infection. Leukocytes are also responsible
for detoxification of toxic proteins, such as caused from allergic
reaction, and cellular injury.
The same record documents a question mark (?) with respect to
possible morphine allergies, and that for "2 weeks"
she had the "flu". The same record
documents bloody bowel movements for 4 days, a sign of possible
diverticulitis
276, a
condition associated with constipation with abnormal increase in the
white blood cell count, indicative of infection,
mucous, and blood (concealed hemorrhage) in the
stool or passage of bloody stool. No
Stool O & P test was done. There is nothing on record to suggest
that a
stool
culture test was done. The
majority of people with diverticula are asymptomatic
277.
MORPHINE IS CONTRAINDICATED because of it抯 constipating properties.
GI bleeding is the most serious source of bloody stools
278.
Studying Stools
The patient had a history of MS Contin
279
(morphine), Tylenol with Codein
280
(acetaminophen), Aspirin
281, and
Demerol
282(meperidine) use.
Compare: Acetaminophen Toxicity
283
(Analgesic Toxicity). Hepatotoxic
284
drugs including acetaminophen can cause high serum bile acid
285
concentration. Symptoms of acetaminophen
overdose include hepatic necrosis
286,
transient azotemia
287
, renal tubular
288
necrosis with acute toxicity, anemia, including toxic anemia
289, and
GI disturbances with chronic toxicity. Shock may also occur as the damage of the GI tract leads to fluid and blood loss. A patient can die in this phase due to progressive circulatory failure and coma if not treated promptly. See also :
Renal artery occlusion Compare:
Azotemia - Alternate Names : Prerenal
290,
Renal Underperfusion
291,
Uremia 292.
Azotemia is a toxic condition characterized by uremia as caused by the
retension in the blood of excessive amounts of nitrogenous compounds such as ammonia which can cause renal failure due to disposal in the KIDNEY, as well as liver dysfunction, and neurologic damage. See Metabolism
of nitrogenous compounds Compare Anemia
293
resulting in insufficient oxygen to tissues and organs.
Azotemia is a toxic condition in which
iatrogenesis
294 often underlies acute renal failure.
Compare:
Renal vein thrombosis See:
Nephrotoxic injury Compare also microangiopathic
hemolytic anemia
295 .
Compare Symptoms: Bleeding From the Digestive Tract
296. See:
Kidney function tests Compare:
Kidney nuclear medicine scan
eMedicine
- Radiation Necrosis Demyelinating
Diseases
See: UREMIC ENCEPHALOPATHY
297 in
which hepatic encephalopathy
298,
uremic encephalopathy
299,
drug intoxication/withdrawal are prominant findings associated with
altered mental status
300.
Compare Iatrogenic Hepatic Encephalopathy. See Chapter
Submission Evidence Based Gastroenterology.
Notably, the record does NOT take into account the many other
medications prescribed or administered by the patient's Oncologist,
Dr. Hugh Prichard
301 over
the course of her Radiation
Therapy
302,
between March and the end of April of 2000. i.e. Senokot
304 for
constipation, side effects of which include "severe stomache pain",
and unusual change in color of urine, i.e, "tinged-urine"
305
as evidenced on the record. Further, Arlene Berry
had also been prescribed sodium phosphate
306, a
hyperosmotic laxative
307 that
has many precautions which had not been disclosed to this patient,
and is prescribed for poor
appetite, vomiting,
constipation
(particularly when caused by other medicines)
and muscle weakness which may be severe enough to cause paralysis of
respiratory muscles due to low serum potassium levels (hypokalemia)
in
Renal Tubular Acidosis
. Renal tubular acidosis is a
condition or disease in which the kidney does not take acid out of blood
and put it into urine like it should.
Proximal renal tubular acidosis is associated with other tubular disorders
Distal renal tubular acidosis is associated with multi system disorders.
Common signs and symptoms of RTA include anorexia, nausea, vomiting,
constipation and may also include UTI. Compare PMS - Docusate Sodium
See Rx list
Compare Sennosides
308
According to my research, Tylenol long term in doses as low as
3g daily can produce a chronic hepatitis-like
309
picture that mimics
310
liver disease in which
Liver function tests
311 are
typically unremarkable. Medication effects and other
systemic diseases as causes mandate a thorough drug history. See
Alanine aminotransferase test
Aspartate aminotransferase test
According to the record, Arlene Berry had also
been given Amoxicillin
312 for
infection. Staph infections in the bladder are
sensitive to Amoxicillin. Amoxicillan belongs to a class of penicillin-like
313
drugs, side effects of which include
"severe nausea and vomiting", including "abdominal pain". Amoxicillin is regarded as having a fairly broad spectrum against many bacteria.
Additionally she had been given Statex
314 ,
a narcotic: opioid agonist analgesic
315 used
to relieve pain which also belongs to a class of the Morphine
family. See:
Analgesics, opioid
A-12 of the medical record documents a
blood pressure of 163/117 at
03:20 hours that by 03:45 hours had dropped to 85/58,
and again to 85/52 by 3:52 hours, over a span of
7 minutes, as evidenced at
N-2
in the Nurses' Notes..
Notably also, constipation, fecal impaction
316 and
bowel obstruction
317 are
common problems for oncology patients. Further, when there is a weak
area of the bowel that is sluggish and toxic, there is the
possibility of these waste products being re-absorbed
back into the system, usually migrating back into the blood ,
then settling in the various weak tissue areas through out the body. Compare : Appendicitis
N-10
of the Nurses' Notes document the patient's level of care as "routine",
which showed very little concern for the patient.
What I take to be a continuation of the same record at
N-11
documents "vomiting, lung CA". There
are NO further entries on that two-page assessment.
From the record it seems clear that there was every indication that
Arlene Berry was about to suffer a catastrophic decline
318, at
least from foreseeable dehydration due to decreased oral/water
intake and excessive vomiting over the previous week or more
which ought to have prompted immediate medical attention but did NOT.
Vomiting as such, or
retching can lead to esophageal
319
rupture.
Dr. Jordan's "discharge note" at
A-1
documents that she was "afebrile"
320
(without fever), while the record at
A-26 documents a body temperature above >37.0
degrees C
321. Blockade of dopamine in the hypothalamus can cause impaired temperature regulation and hyperthermia in NMS. Neuroleptic malignant syndrome (NMS), is a life-threatening derangement that also affects multiple organ systems . Compare Toxicity, Neuroleptic Agents. NO drugs to counteract neuroleptic drug side effects were given in this case. See: Evidence of Neuroleptic Drug-Induced Brain Damage in Patients.
Submit that a patient can also "afebrile" (without fever) and still have Toxic Shock Symdrome
322 . The same record at A-26 documents a blood pressure of 162/80 at 0220 hours
that by 0235 hours had dropped to 78/70.
============================================================================
In the upper right hand corner of the same report Dr.
Jordan documents 3 sets of numbers which I have traced to the
International Classification of Disease Code
323,
namely anorexia
324 ,
joint pain 325,
and urinary tract infection
326. Note the hand scripted numerical notations from
the ICD Code, i.e. 784.0 =Headache, 787.3
Gas/bloating , and 599.7 Hematuria . Findings are non-specific due
to variations in the published literature.
==============================================================================
The same record seen at A-1
documents "plantars upgoing bilaterally"
327.
Submit that upgoing plantar responses are associated with hepatic
encephalopathy, including Status epilepticus
328 and
is also associated with intracranial
329
infection, ie. meningitis
330 which
can result in brain herniation
331,
meningoencephalitis
332, or
cerebral abscess
333 which
can result in shift of midline
334
structures.
The same record documents Dr. Jordan's "I
was called in later that night because she had become obtunded"
336, (also
a sign of severe dehydration), while
N-6 of the nurses' notes documents obtundation as evidenced by the
"no response to verbal or physical stimulation" as early as 0030
hours on May 23rd of 2000, a considerable passage of time from when he
was called in and eventually showed up. Further, there is a complete
absence of documentation with respect to the patients blood pressure
between 18:45 hours on May 23rd, and 00:40 hours on May 24th,
which suggests deliberate
omission, as evidenced at
N-6, and
N-5 of the record.
A-8 of the related record documents "patient
was unconscious with respirations of approximately 30 and laboured"
338 ,
that is consistent with
dyspnea
339 - difficult or labored respiration.
Dyspnea
is breathlessness due to high filling pressures and pulmonary
congestion/edema
340, i.e.
shortness of breath, a smothering feeling, inability to get enough
air, and suffocation
341.
Cardiac
asthma which is dyspnea with wheezing, a non productive cough, and
loud gurgling sounds are suggestive of
pulmonary
edema (Thelan, et al.1996)
342.
Compare Incidence and characteristics of preventable iatrogenic cardiac
arrests 343
. Dyspnea can also be caused by a variety of conditions,
including metabolic , allergic, psychiatric, and neuromuscular disorders
344,
and by pain. Dyspnea most often has a
cardiac or pulmonary etiology, although occasionally other causes,
such as anemia, acidosis or neuromuscular disorders,
must be considered However, cardiac and
pulmonary disorders are the most common causes
345.
In heart failure
346,
dyspnea may result from excess fluid in the lungs. Many
antipsychotic
347 medications are associated with Risk of Cardiac
Effects . ?A cardiac evaluation
348 is
important in virtually all patients with brain ischemia
349 . Not
only are cardiac and aortic embolism
350
common, but many patients with cerebrovascular occlusive
351
disease have concurrent coronary heart disease. Occasionally, aortic dissection presents with symptoms referable to an acutely occluded artery (eg, stroke, MI or intestinal infarction, paraparesis or paraplegia from interruption of the blood supply to the spinal cord, an ischemic limb). Such presentation may mimic arterial embolism.Compare:
eMedicine - Pulmonary Edema, Neurogenic : Article by Sat Sharma
352 ,
... Neurogenic shock- loss of vascular tone due to anesthesia or
spinal
cord injury
353.
Compare Fluid and Electrolyte Balance
354. See:
Electrolyte disorders
A-5 documents Dr. Jordan's "no change in orders" at
0100 hours. Further, the same record documents that Dr. Jordan was
notified of the patient's condition at 0225 hours on May 24th and
he showed up at 0305 hours on May 24th, as evidenced by the record
at N-4
of the nurses' notes.
At the time of her admission to the hospital, Arlene Berry's
Blood pressure was documented at 115/70, with a
pulse of 79 and regular, a respiration rate of 18, with
signs of mild diffuse (widespread) weakness as evidenced by
the record at
A-6. At the time of that assessment she was found to be
"alert and oriented", with "NO Focal deficits"
355.
Multiple brain abscesses
356
may not cause focal deficit to suggest their presence. The bald truth
however, is that Arlene Berry had presented with signs and symptoms of
dehydration and possible hepatic
dysfunction at the onset, signs and symptoms which Dr. Spiller, in
his professional capacity as the ED physician failed to
recognize until it was too late. Further investigations suggest that
Dr. Spiller had been a local appointed coroner
357,
working under Dr. Barry McLellan
358, the
Regional Coroner. Also, Dr. Mark Spiller sits on the Board of Governors -
Kirkland and District Hospital, a hospital in partnership with the N.O.R.T.H. Network
359
which had been headed by Dr. Barry McLellan.
Further, when a coroner's opinion10
comes into conflict with a consensus of leading authorities,
perhaps its time to question his train of reasoning, in contrast to
what is embedded in
Universal health care practices, and also
submit that his long standing silence concerning the Arlene Berry
death cover-up constitutes his active and ongoing concealment.
According to the hospital record, Arlene Berry
was admitted to the Kirkland and District Hospital on May 23rd of 2000 by
Dr. Spiller with
flu-like signs and symptoms suggestive of a bout of the flu.
There was emesis of yellowish fluid
360, what
is termed as
Bile
361.
Compare:
Biliousness.
362 .
Biliousness - Medical Dictionary definitions of popular medical
...
When the bowels stop working the body gets toxic.
Biliousness is "a symptom of a disordered condition of the liver
causing constipation, headache, loss of appetite, and
VOMITING of bile"
363.
When Red Blood-Cells complete their life cycle and break down
naturally in the body they produce a "yellow pigment"
364 which is then passed to the liver and excreted into
bile.
Initially, the vomitus was yellow in color but a later episode may
have been greenish
365 as
evidenced by "large queery bloody emesis" which quite frankly was vomit resembling feces, as evidenced at
N-5 of the Nurses' Notes. Any vomiting at or following the time of her admission characterized by "yellowish" would be considered "bilious
emesis"
366 and is suggestive of a more significant back up of
intestinal material. See: INTESTINAL OBSTRUCTION.
Compare Hepatobiliary System
367 -
Biliousness, including Hepato-Biliary & Gastro-Intestinal Summary
of Clincial Indications .368
... Compare Symptom: Vomiting - green vomit, fecal
associated with Bowel Obstruction.
369. When
bile is present, the vomit is greenish , or yellowish.
... 370
Compare
Primary biliary cirrhosis
THE MERCK MANUAL--SECOND HOME EDITION,
Symptoms in Ch. 119 ...
Bowel obstruction information - encyclopedia article about Bowel ...
Shock, circulatory ?Medical Diagnosis [PDF] Circulatory Shock Reading
Assignment
File Format: PDF/Adobe Acrobat - View as HTML Compare HYPOTENSIOM Bilious
Emesis suggests Small Bowel Obstruction - Emesis stained greem with bile.
Reference: TSS- Cached
Note: Even small doses of opiods, in combination with other factors
like decreased fibre and inactivity, can lead to
constipation. In some cases, complete bowel obstruction may happen
on even small doses of opiods which may result in the person
vomiting feces. In my opinion, that is what
happened in this case. This can be minimized with proper
attention to constipation early on. The person may need an appropriate
and effective stool softener as well as
Laxatives.
Arlene Berry was still neurologically responsive when I saw her following
her admission. In fact, she was able to reach and use for herself the
kidney basin at her bedside table as she occasioned to vomit more of the
same flu-like yellowish bile (bilious vomitus) that she had done
so many times on the days before, and she used it for herself in our
presence at which time a cool cloth was provided by the nurses
as evidenced by that record. It seems clear that generally a cool
cloth is provided when a mild or low grade fever
371
is present.
The same record documents that the patient had stated that she was
then "feeling a little better", whereupon
she was then assisted to bed. From that record it seems clear that she
was at least benefiting from Hydration. That the effects of the
given medications had not yet taken effect should also be borne in mind.
The record at
N-6 also documents telephone orders
received by the hospital from Dr. Jordan at 2030 hours for the drug
"Stemetil" 10mg by IV 4
times daily for "control of nausea", given by the RN, as
further evidenced by the physician's orders seen at
A-11. Stemetil is an antipsychotic medication. It seems clear that when antipsychotic drugs are prescribed, the underwriter is usually dealing with a significant psychotic disorder (usually, these drugs
just aggravate an underlying hematologic disorder). Further, Stemetil has a cardiotoxic metabolite.
It is also clear that the patient was given Stemetil/Prochlorperazine
372
during and after she was in an altered state of consciousness resulting in neurolepsis to the point of loss of consciousness, coma and irreversable brain damage.
373 at
that time, as evidenced by extreme somnolence. Further, she stated
that she was very tired. Those were the last
words spoken by Arlene Berry. It is also clear that Dr. Jordan
sought to eliminate the symptom "nausea" without his attendance,
as evidenced by the phone order "for control of nausea" and without
addressing any possible underlying cause. Also, Dr. Jordan neglected
to consider the etiology of the nausea and vomiting as a condition
requiring medical intervention.
An altered mental state = infectious, inflammatory, ischemic,
traumatic, and metabolic disorders, as well as poisoning, adverse effects
and dehydration, all of which can affect sensorium
374 ,
causing anything from minor cognitive deficits to agitation,
lethargy, confusion, seizures, paralysis, and coma. In this case NO
close monitoring or toxicological screening was done.
A typical single dose of Stemetil
375
for a small woman with low body weight is 5mg.
Arlene Berry was given 10mg, (possibly
x4) double the recommeded dosage,
together with other medications. See Drug Induced Liver Toxicity
376
. See:
Hepatitis, drug-induced
Adding insult to injury, Stemetil/Prochlorperazine enters the
enterohepatic
377 circulation and is excreted chiefly in the feces. The
drug undergoes metabolism in the gastric mucosa
378 and on
first pass through the liver. Anti-emetic effect of
prochlorperazine is diminished by its low bioavailability owing to a
significant gastric and hepatic first pass effect. See:
Antinausea drugs
According to my investigation, Stemetil is
classed as a phenothiazine
378 that
is widely distributed into body tissues and crosses the blood-brain
barrier 379
. The drug is highly plasma protein
380
bound (91-99%) and has a duration of activity from 4 to 6 hours.
Prochlorperazine is widely distributed into body tissues and fluids (in
this case tissues and fluids containing gram-negative bacteria in
which disseminated bacteria can cross blood-brain barrier) and crosses
the blood-brain barrier due to increased penetration of the blood-brain
barrier Infection is rapid once organism crosses blood brain-brain
barrier (BBB). The BBB function is preventing or slowing the passage of various chemical compounds, radioactive ions, and disease carrying organisms from the blood into the CNS. Further, findings suggest that from the lungs, S.
pneumoniae 381
often invades the blood, crosses the blood-brain
barrier, and enters the meninges
382.
Compare hemolytic
383
findings. Compare also Iatrogenic peritonitis
384.
Prochlorperazine/Stemetil is a phenothiazine piperazine
derivative in addition to being an antipsychotic
385 with a
piperazine side chain, similar to trifluoperazine
386 and
fluphenazine 387
. Because of the similarity in antiemetic
388 action
of the trifluoperazine component, Stemetil should NOT be used
where nausea and vomiting are believed to be evidence of intestinal
obstruction or brain tumor, for the same reasons as Stelabid
388 , for
example.
Stemetil (prochlorperazine) is a "high-risk"
389
antipsychotic-antiemetic drug to be used with caution, according to
manufacturer's directives. Indications of prochlorperazine are primarily
in the management of "psychotic disorders"
390. Further, "unexplained, sudden deaths"
400 have
occurred in hospitalized patients treated with this type of drug. The
adverse effects of phenothiazines can affect all organ systems and
may be attributed either to the drug's effects on the central and
autonomic nervous system, or to hypersensitivity reactions to the drug.
Compare
Sudden cardiac death
Symptoms of overdosage include CNS
401
depression which may vary from simple lethargy to coma. Other
possible manifestations include convulsions
402,
autonomic reactions such as
Hypotension
403, and
ileus 404
. Compare: Phenothiazine associated with Poisoning.
CAVEAT: Prochlorperazine is contraindicated to liver
or renal dysfunction and in hypotension. Most serious
side effects include hypotension, liver toxicity, and blood dyscrasias.
Compare: hypotension (severe drop in blood volume) a vascular collapse - called endotoxic shock = septic shock
Shock... also associated with septicemia, usually by Gram-negative (endotoxic shock) bacteria . Compare Sepsis
Stemetil is contraindicated in the presence of circulatory collapse
405,
altered states of consciousness or comatose states
406 ,
particularly when these are due to intoxication
with central depressant drugs
407 . It
is contraindicated in severely depressed patients, in the presence
of blood dyscrasias
408 ,
liver disease
409, renal insufficiency
410,
pheochromocytoma
411, or in patients with severe cardiovascular
412
disorders or a history of hypersensitivity to phenothiazine derivatives.
Blood DYSCRASIA = any abnormal condition of the blood
413.
Stemetil must not be given to anyone who is unconscious or
in a coma. In this case it was given regardless of
contraindications, suggests wanton and reckless
disregard for human life.
414 .
Compare: Anticholinergic Syndrome
415 in
which the clinical diagnosis is based on the appearance of the
anticholinergic toxidrome
416 , ie.
altered mental status, disorientation, incoherent speech, somnolence, confirmed.
coma, central respiratory failure, and, rarely, seizures. Compare: Toxicologic Emergencies.
The use of Stemetil is CONTRAINDICATED to emesis in coma, trauma, toxic
syndromes, and in anyone with impaired airway or laryngeal cough reflexes
and can result in POISONING
417
- suggests wanton and reckless disregard for the patient's safety as
to constitute criminal negligence. The possible roles of
airway compromise during and prior to intubation and or aspiration
418 of
vomitus are difficult to assess.
CAVEAT:
Aspiration pneumonia most often occurs during anesthesia, or during a seizure, or other condition characterized by vomiting and decreased level of consciousness. Aspiration of vomitus containing acid-gastric content can also cause asphyxia, as can poisoning.
Loss of airway is the most lethal toxicological complication
419.
=================================================
There are two things for certain: 1) there was "yellowish bile"
vomitus at the time and shortly after the patient's admission to the
Kirkland and District Hospital on May 23rd of 2000, and 2) there was
"bloody emesis of redish brown", and "coffee-ground vomitus"
following admisistration of the drug Stemetil?
===========================
From these records it is clear that Dr. Jordan elected to alienate and
treat this patient unseen (at arm's length), over the telephone
and without first any review the patient's files, akin to driving
in the dark at night with NO lights, tantamount to "criminal
negligence".
According to my information, the duty placed on a doctor is to
exercise care in all that is done for the patient which includes
attendance, diagnosis, referral, treatment and instruction.419
It is also clear that this was NOT done, as
evidenced by the record at A-3,
and as reflected in the record as a whole.
Compare symptoms of phenothiazine overdosage in which drowsiness
or loss of consciousness, hypotension, tachycardia, ECG changes, ventricular
arrhythmias
and hypothermia are common. Compare the medical record of Arlene
Berry for May 23rd, and 24th of 2000. Compare tachycardia in cardiac
arrhythmias. See:
Prolonged QT syndrome
The antiemetic action of prochlorperazine may "mask the signs and
symptoms of overdosage" of other drugs and may "obscure the
diagnosis and treatment of other conditions" such as intestinal
obstruction. . Deep sleep, from which patients can be aroused, and
"coma" have been reported, usually with overdosage.
The record at 0020 hours seen at
N-6 documents the patient's discovery by duty nurses of the patient's "head against the left side bed rail with her feet under the right side rail" and "without response" to either verbal or physical stimulation that is consistent with a Dystonic reaction to the neuroleptic drugs, and a comatose state. When that happens any negligence of the patient¡¯s throat secretions may lead to hypoxia, brain edema and further deterioration in a patient's condition leading to a vicious circle, which if not broken will lead to death. Compare Iatrogenic Causes.Dystonia is defined as a movement disorder
characterized by sustained muscle contractions, frequently causing
twisting and repetitive movements (also associated with tonic-clonic
seizure provoked by drug toxicity) or abnormal postures that can
result in distorted postures. Compare dystonia secondary to
brain insult.
Dystonia can occur after exposure to a variety of different types
of toxic substances, such as Stemetil. Dystonic reactions
and akathisia occur most frequently in the young, especially
those with "acute infections or severe dehydration".
Antipsychotics, antiemetics, and antidepressants
are the most common causes of "drug-induced dystonic reactions": these
are characterized by intermittent spasmodic or sustained involuntary
contractions of muscles in the face, neck, trunk, pelvis, and
extremities. Predisposing factors include either a family history of
dystonia, or viral infections.
Idiopathic spasmodic torticollis (IST) is considered a focal
dystonia and is associated with neuroleptic toxicity, triggered by IV
use of prochlorperazine. Compare dyskinesia (drug induced)
with opisthotonus, spasm of the body where the head and heels
are bent backward and the body is bowed forward. It occurs with
"drug-reactions" and "infusions"
in Neuroleptic Malignant Syndrome.
Reference: Drug induced Rhabdomyolysis in which
drug-toxicity involves organs, such as the kidney, liver, gastrointestinal
tract and the central nervous system, with skeletal muscle being usually
less readily affected. Most cases of drug intoxication may be associated with rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle fibers
resulting in the release of muscle fiber contents into the circulation.
Drug-Induced Rhabdomyolysis from all cases leads to inadequate
blood-perfusion and subsequently acute renal failure. In patients
with rhabdomyolysis, cardiogenic shock or cardiorespiratory
arrest may occur exceptionally. Compare Systemic Hypoperfusion
in which brain ischemia due to inadequate cardiac output with systemic
hypoperfusion can be caused by acute myocardial infarction, cardiac
arrest, and life-threatening ventricular arrhythmias. Less common causes
are pulmonary embolism, acute gastrointestinal or systemic
bleeding, and shock.
Neuroleptic Malignant Syndrome (NMS) is characterized by
"alterations in consciousness, altered mental status, and autonomic
instability Sinus Tachycardia (Sinus tachycardia is one of the earliest signs of muscarinic receptor blockade) low blood-pressure or
hypertension)".
The medical record of Arlene Berry documents evidence of same.
Further, NMS can present without fever in an "afebrile" patient.
The same record documents "dilated pupils" that is consistent with
and suggestive of anticholinergic syndrome associated with the drug
Stemetil. The clinical diagnosis is based on the appearance of the
anticholinergic toxidrome. Compare ACUTE ANTICHOLINERGIC SYNDROME
in which the clinical features include central anticholinergic signs
and symptoms, ie. altered mental status, somnolence, coma, and central
respiratory failure due to central anticholinergic toxicity
which can ultimately lead to coma, circulatory collapse, and death.
Compare also signs and symptoms of shock. Physostigmine is a
specific antidote for anticholinergic poisoning. In the case
of Arlene Berry, NO antidote was given.
Compare Neurological Emergencies: Coma, Seizures, Syncope,
Stroke. See:
NINDS - Neurological Disorder Information
Compare Gastrointestinal Complications: Causes of hypovolemic shock include blood-loss due to trauma or gastrointestinal bleeding, and is also associated with bowel obstruction.Compare Shock Causes.
The admitting physician, Dr. Spiller, was up to assess the patient's
condition at 0055 hours as evidenced at
N-5. Upon examination he documented the patient's eyes as
being "sluggish", noting no response to "deep pain".
The patient was simply "repositioned" by the nurses as evidenced
by the record at N-6.
From that record it seems clear that the patient had suffered a near
fatal reaction to the given medication at that time and that far
from getting better she was becoming progressively worse, as
evidenced by a sense of urgency seen on the record to the
attendance of the patient with increased activity documented during
that time period and the ED physician, Dr. Spiller "up to
assess" the patient between 0030 hours as evidenced at
N-6 and also at 0055 hours as evidenced at N-5
of the Nurses' Notes. I assume that Dr. Jordan would have been
alerted.? According to the record he called in at 0100 hours
but nevertheless opted not to change his orders as evidenced by his "no
change in orders" also seen at
N-5.
From that record it seems clear that both doctors should have realized
that they were faced with a critically ill young woman who was not
responding to treatment and they should have been acutely aware of the
danger. It is also of interest to note that NO attempt was made by
either of the doctors to place the patient in the ICU at that time,
between 0030 and 0055 hours.
It is also clear that the patient continued to receive the
prochlorperazine even after she had become comatose. There is
absolutely nothing on record to suggest that the offending drug was ever
discontinued or withdrawn. No
Stomach flushing was done.
Further, between 0200 hours and 0220 hours her Blood
Pressure had risen from 150/72 to 162/80, a sign of
mounting hypertension such as caused or worsened in response to
treatment. The record at
A-26 documents the time of that assessement as 0220 hours,
while
N-5 documents the time of the same assessement at 0230,
but for whatever reason appears to have been written over.
The same record documents a Heart Rate (HR) in the 160's
with a rapid drop in blood pressure (BP) to 98/70 by 0235
hours. The earliest indication of shock is an increase in heart rate. Septic shock is a potentially lethal drop in blood pressure due to the presence of bacteria in the blood. Compare hypovolemic shock.
By 0220 hours the patient's respiration rate was documented as "deep and soaring and without constant jaw thrust", a sign of constriction. The same record at N-5 also documents "gurgly respiration" which can suggest Thoracic trauma such as associated with the airway and swollowing.
|
Gurgly respirations are associated with fluid
(air/fluid) in upper airway that is
consistent with
obstructed airway, or
dysphagia (swallowing difficulty) or depressed gag reflex
and diminished respiratory drive associated with adversities
associated with antipsychotic medication, and in particular
toxic neuroleptic agents, or opiod poisoning.
The quality of
breath sounds may help in determining the level of obstruction.
Oropharyngeal obstructions tend to be "gurgly;"
while laryngeal or upper tracheal obstructions are usually "raspy"
or stridorous. See:
Stridor Direct tracheal
suctioning should have immediately been
performed to remove meconium from the airway.
Compare rales on pulmonary exam
which can suggest
left ventricular (LV) dysfunction or mitral regurgitation
- (pulmonary
rales suggests systolic heart failure)
MedlinePlus Medical Encyclopedia: Breathing sounds - abnormal ...
Dysphagia associated with the drug Stemetil, points to "bowel
obstruction", and is also associated with "RADIOTHERAPY-INDUCED
ACUTE GASTROINTESTINAL TOXICITIES". Compare Profiles and Time
Course of Acute Radiation Toxicity Symptoms ...
Inability to swallow results in drooling (patient requires
suctioning), and is associated with Parkinson-like symptoms.
Drug-induced parkinsonism is commonly produced as an adverse effect
in
antipsychotic
drug herapy. Abnormal sounds in the lungs is also
associated with inflamatory disorders of the esophagus,
gastroesophageal reflux, fluid around the lungs, fluid in
lung (pulmonary edema) and/or pulmonary
edema associated with congestive heart failure.
See: Antiparkinson
drugs
Tardive dyskinesia are involuntary movements, especially
of the lower face, that develop after exposure to a group of medications
known as neuroleptics. The drug Stemetil is such a
medication. Short spasmodic contractions of the right leg were observed
by family following intubation of this patient. The abnormal
movements include tongue thrusting (Protrusion of tongue), which explains the nurse's use of
the plastic oral airway, and the "without continuous jaw
thrust" documented at
N-3 of the Nurses' Notes.
Tardive Dyskinesia is a serious, irreversible neurological disorder. The same record at
N-3 documents a Blood Pressure of 163/70 at 0320 hours
that by 0352 hours had dropped to 85/52. Compare neuroplegia,
nerve paralysis as caused by neuroleptic drugs. Neuroplegia
was born from a physiopathological study of states of shock.
Prochlorperazine has neuromuscular blocking effects. The combination of peripheral alpha-blockade and dehydration may result in severe hypotension during
overdose.
Further,
N-5 of the record documents "family in" at 0250 hours.
"On seeing the patient, we found her to be propped up in the arms of two
nurses, gasping for air, with only a plastic oral airway in her mouth".
The same record at
N-5 documents a rapid drop in Blood Pressure to 98/70
at 0235 hours with physician "assessments unchanged" despite
the fact that the patient had already gone into respiratory distress,
as evidenced by "Cheyne-Stokes" respirations with periods of "apnea"
lasting "5-8 seconds". Obstructive sleep apnea may cause a stroke. Central
sleep apnea is particularly linked with heart failure.
High blood-pressure, actually hypertension, which is associated with sleep apnea,
is also a major cause of later heart failure. Stroke victims
with sleep apnea tend to have higher levels of blood protein fibrinogen
than stroke victims without sleep apnea. Fibrinogen is a factor in
blood that causes it to clot. Higher levels of fibrinogen have been
linked to both stroke and heart attack risk. High levels of
fibrinogen represented a significant risk factor for both heart attack and
ischemic stroke. Reference: The Fibrinogen Test.
Related Information. Fibrinogen Links .
Notably, the central mechanisms that regulate breathing fail in severe
hypoxia leading to irregular respirations, Cheyne-Stokes
breathing, apnea, and respiratory cardiac failure in
which hypoxia leads to obtundation. Cheyne-Stokes breathing
is a respiratory pattern that oscillates between hypoventilation and
hyperventilation.
Lack of blood-supply and/or
lack of adequate oxygen delivery causes hypoxic damage to the nervous
system: Apnea is due to airway obstruction caused by major
decreases in pharyngeal muscle activity.
The cause of hypoxia is relatively easy to understand. It simply
means that the blood is well oxygenated; there is enough oxygen carrying
agent (hemoglobin) in the blood; the blood-flow (CO) is good enough to
carry the oxygen rich blood to the tissue, but the tissue cannot
utilize the oxygen since there is a toxin present that
prevents oxygen uptake by the cells. Shock, is defined as a reduced
tissue perfusion. Shock, in this case is therefore confirmed.
Hypoxic comes from the Greek word "hypo" meaning "under",
the word "oxygen," and the Greek word "ikos" meaning
"pertaining to". ischemic comes from the Greek word "ischein"
meaning "to hold back" from the Greek word "haima" meaning
"blood" and the Greek word "ikos" meaning pertaining to". The word
"encephalopathy" comes from the Greek word "enkephalos" meaning
"brain," and the Greek word "pathos" meaning "suffering."
Put the two words together and you get "brain suffering".
Further, there is nothing on record to suggest that the patient was
adequately oxygenated prior to intubation and from these records it is
also clear that the health care providers withheld life support
for the purpose of accelerating death following iatrogenic
injury when the patient became critically ill. A plastic oral airway
does NOT provide needed oxygen.
The same record at 0255 hours documents a "sudden large
bloody-emesis of reddish brown" or what is known in medical circles as
"coffee-ground emesis" ie. dark brown tinged vomitus the color
and consistency of coffee-grounds composed of gastric juices and
old blood, old blood which can grow coagulase negative
staphylococci indicative of a slow bleeding source in the upper
GI tract. The presence of blood in the gastrointestinal tract results
in increased ammonia and nitrogen absorption from the gut,
and may also predispose to kidney hypo-perfusion. Dark or brownish blood usually indicates that blood is coming from a kidney or ureter. Vomit that contains
blood may have a red or brown appearance. Other findings suggest that brown vomitus contains feces - indicating that it has come from large intestines. Obstruction below the middle of the small bowel also gives rise to brown vomit.
Blood-containing methemoglobin is chocolate-brown color. Clinical signs: dyspnea, sudden death, “muddy?mucous membranes, “brownish?appearance to blood. Methemoglobin can be a sign of Tylenol poisoning. Acute formation of methemoglobin is a life-threatening condition caused by multiple medications.
Ammonia
has multiple brain and neuro-toxic effects, including altering the
transit of amino acids, water, and electrolytes across the neuronal
membrane. Ammonia has been considered the major compound
responsible for hepatic encephalopathy. Compare acute neuro-toxicity
of ammonia in Portal-Systemic Encephalopathy.
Further findings suggest that multiple medications, restricted
diet or poor nutrition causes gastrical intestinal or
GI lesions to GI bleeding. Drugs that are orally administered
are generally absorbed from the gastrointestinal (GI) tract into
the systemic circulation. See:
GI bleeding studies Compare:
Irritable Bowel Syndrome See:
Overview of Drug Interactions. GI
Bleeding ![]()
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Reference: Pathology of Gastrointestinal Bleeding, and flu-like
symptoms associated with Hepatitis C. Compare also Ischemic
Hepatitis - Shock Liver Hepatic ischemia is a deficiency of blood or
oxygen supply to the liver that causes injury to liver cells.
Low blood-pressure resulting from any condition, including heart
failure, abnormal heart rhythms, dehydration, severe bleeding, and
infection can lead to hepatic ischemia.
Gastrointestinal Bleeding is considered a potential medical emergency. From the
record, it is clear that nothing was immediately done to determine a
possible cause of the internal bleeding or to treat accordingly.
The visible evidence is described as hematemesis,
hematochezia and/or melena. In this case there is evidence
suggesting iatrogenic neglect with respect to both hematemesis,
and melena. It is also clear that Dr. Jordan showed no concern for
this patient is spite of her worsening condition. Further findings
suggest that blood turns brownish from lack of oxygen.
Decreased amount of oxygen. = Hypoxia. CompareNINDS
Cerebral Hypoxia Information Page.
GI bleeding studies
Gastro Resource Centre
.
According to my research, gastrointestinal bleeding should have
been controlled if possible and blood purged from the gastrointestinal
tract, but this was NOT done. Further, Dr. Spiller (the ED
physician) did nothing to lessen or prevent the outcome,
suggestive of his complicity, acquiescence, to cover-up for Dr.
Jordan's stupidity, or outright incompetence or other negligence of
his own resulting in further iatrogenic injury.
The record at
N-4 documents the patient's "transfer to ICU" at 0320
hours. The record at
A-27 documents a Blood Pressure (BP) of 163/117
(high BP in response to distress or pain) at the very same time.
A-16 documents a Blood Pressure of 121/81
at 0400 hours, while
N-2 documents a Blood Pressure of 112/57
at the very same time.
The record at
A-24 documents the charting of the patients vital signs that
commenced recording at 0315 hours. It is interesting to note that the
patient's transfer to the ICU had NOT yet taken place, that NO
attempt was made by the healthcare providers to place the patient in the
ICU prior to 0320 hours and further that the patient's condition
remained critical throughout the night and into the small hours of
the morning notwithstanding.
The same record documents a heart rate (HR) of
174 bpm at 0320 hours during the intubation procedure
that is consistent with "clinical insult", such as associated
with deep pain.
77. From these records alone it seems clear that the healthcare providers
had done too little too late for this patient, as evidenced at
N-9,
N-10, and
N-11, and also at
A-3 and A-21
of the medical record.
78. The record at
N-4 of the Nurses' Notes documents "incontinent blood tinged
urine" at 0305 hours that is consistent with impaired water
excretion marked by incontinent urine output suggestive of
possible hyponatraemia.
OP-54 of the Outpatient Record documents "large blood trace
leukocytes" that is consistent with
Staphylococcal infections suggestive of a possible
hospital acquired infection.
[PDF]
Staphylococcal and Streptococcal Infections
Staph Infections: What Causes
Them?
Incontinence is loss of bladder control and is a very
serious side effect of antipsychotic medications such as Stemetil.
Predisposing factors for staphylococci infections include foreign
bodies, including intravascular catheters. Additional findings suggest
the presence of viruses in the blood-stream has been scientifically
shown to induce a physiological state called hypercoagulability.
The risk of venous thrombosis is greater if patients are
dehydrated.
=======================================================================
Compare: Common infectious agents in cancer patients
Hematuria: blood in urine; may also indicate kidney disease
Patients rarely but may appear toxic or septic Compare: Sepsis
Chapter VI.16. Sepsis One infection Staph is
responsible for is sepsis, a blood-poisoning disease
Dartmouth Medical School - Publications
The Toxic Shock Syndrome and Staphylococcus Compare:
Kawasaki syndrome
============================================================================
N-3 of the Nurses' Notes documents a " large amount of "dilute
urine" at 0325 hours, only 20 minutes later, and again at
0450 hours as evidenced at N-1
of the record that is inconsistent with the record as a whole, and
in particular with respect to A-16,
marked by a complete absence of documentation as to water refill
to justify urine-output.
See: Fluid overload, hypokalemia search results associated with
large amount of dilute urine . A search using the terms "hypokalemic,
alkalosis, low blood-pressure, antipsychotic medications" can be traced
to anorexia nervosa, suggestive of iatrogenic anorexia in which the main
causes of nausea and vomiting can be traced to morphine. Other
causes include untreated Iatrogenic Electrolyte Imbalances.
Untreated, these conditions can be life-threatening. Compare:
Overhydration
Anorexia Nervosa (Latin term meaning "nervous want of appetite")
is a potentially fatal eating disorder. It can also have iatrogenic
causes. COMPARE: Dangers Of Anorexia in which death is attributed to
but not limited to any combination of the following: heart attack or
heart failure; lung collapse; internal bleeding,
Stroke, kidney failure, liver failure; pancreatitis, gastric
rupture, and perforated ulcer. These are but a tip of the iceberg
consequences of eating disorders precipitated by medical
treatments/procedures leading to heart arrhythmias, shock or
myocardial infarction. Compare Disordered eating.
It is also of interest to note a complete absence of
documentation with respect to the patient's elimination pattern for
toileting, as evidenced at N-10
of the record that is consistent with
Constipation. The failure to document that information is
further proof of negligence on the part of the health care
providers.
Further, there are numerous material deficiencies in the related
medical records in which several pages of documentation manifest a lack
of internal consistency ranging from out of sequence reports,
such as seen in the Triage Record at
A-5, to obviously rewritten, altered and
falsified nursing notes seen at
N-1, N-2,
and
N-3 of the record, marked by error, inconsistency,
omission and contradiction, to the Ventilation Record
seen at
A-16, and
A-17 presenting similarly with self-serving entries, i.e.
needless explanation of events, such as "without adversities", to
N-4
and
N-5 presenting with less than half a page suggestive of
deliberate omission, and multiple write-overs with respect
to date and time that clearly suggest that the author was neither oriented
to time or date, and authenticated by what appears to be the initials
'JM', what I take to be that of of the RN as evidenced at
A-15 of the record signed by what appears to be the name "J.
McCrank".
80. The Physicians Diagnostic Sheet at
A-3 ought to have been placed on the record at the time of the
patient's admission, as well as the Emergency Record seen at
A-4,, neither records filed in chronological order, both of
which were dated using a "rubber stamp", suggestive of
backdating.
81. Further, the Ambulance Call Report was filed on the record at
N-7 , and
N-8 of the Nurses' Notes. That document ought to have been
placed on the patient's file at the time of her discharge when she was
sent out to Sudbury, according to the time of that event.
A-9 of the record, Dr.
Jordan's Critical Care Note documents the "Medi-Vac team were due
to arrive at approximately 0435" hours, while the Ambulance
Call Report at N-8 documents the time of the call event for call
received at "0620" hours.
The record at
A-6 documents the patient as having a "history of metastatic
lung cancer", while the record at
OP-54 documents "NO metastasis", and the
Mediastinoscopy which test samples of the cells and
lymph nodes for examination under a microscope are clearly documented as
being "NEGATIVE.". Mediastinoscopy is also used to
stage lung cancer. Both of the aforementioned records document the
results of the testing that was done at the Timmins & District Hospital on
May 16th of 2000.
There are several late dictations, all of them questionable, and I
can count at least 3 two-page documents seen at
A-1 through
A-2,, including
A-6 through
A-7, and also at
A-8 and
A-9 of the medical records, as evidenced by the times and dates
upon which they were dictated and transcribed.
Further, A-4 of the record, what I take to be a Trauma Legend barely visible in the Physician's Notes situated at the lower right hand side of that page there is an obliterated area suggesting perhaps a "white-out", or erasure. There may be others but due to the fact that these are photocopies and not the original records they are not well opacified, however further and other evidence may present similarly upon forensic examination. Trauma is defined as any insult to the body. Obviously the variety of clinical insults is tremendous.
A-1 of the record documents "she had a left lung pneumonectomy
back in October of 1999", which is erroneous.
A-17 also documents the "removal of left lung in '99",
the very same error , suggestive of having been copied.
The same record at
A-1 documents "I was called in to see her later that night
because she had become obtunded ". According to the record at
N-6, it seems clear that the patient had already become obtunded
(unresponsive) as early as 0030 hours, as further confirmed at
0055 hours when the ED physician was up to assess the patient
condition, prior to the time Dr. Jordan phoned in regarding the patient's
condition, as evidenced at
N-5 of the hospital record.
A-1 of the record also falsely documents "she died several
days later with numerous metastatic lesions to her brain". According
to the Death Certificate, Arlene Berry died May 24th of 2000,
the very same day, unless the death cetiificate was falsified.
What I take to be the Ventilation Record at
A-17 documents the arrival of the ventilatory therapist,
Helene Studholme in the ICU at 0330 hours after being "called
in for patient requiring ventilation."
N-3 of the record documents the time of the patients intubation
by Dr. Jordan at 0325 hours, 5 minutes earlier, suggesting
that Dr. Jordan intubated the patient unassisted. The same record
documents patient "suctioned down ET tube several times for small
amount of brownish mucous", suggestive of old blood and/or gastric
juices , while A-17
documents the patient as "being suctioned for moderate amounts of
coffee-ground emesis by RN" at 0330 hours that is consistent
with GI bleeding.
N-2 of the record documents the ET (endotrachial tube)
"pulled back" at 0425 hours. The patient was intubated at
0325 hours, one hour earlier. From that record it is also
clear that the Endotrachial Tube or ET had been "malpositioned"
one full hour before the error was discovered by one of the
nurses, as evidenced by that record. Both myself and the patient's foster
brother were present to witness that event.
According to my research, women have a greater chance of iatrogenic
injury from endotracheal tubes, because their tracheas are smaller and
thus are at higher risk for iatrogenic tracheobronchial tear. In
traumatized tissue, bacterium produces many toxins. Further,
prolonged suction can result in infection if the mucous membranes are
traumatized. Further, the coagulation cascade starts when tissue factor is exposed to the bloodstream due to a cut or other injury.
According to my research, when an endotrachial tube is misplaced in
the esophagus and misplacement is detected late, the
compromise of the patients safety can be significant. Perforation of
a viscous into the peritoneal cavity, i.e. the intra-abdominal esophagus,
or other trauma related cause in which ascites may become
infected secondary resulting in spontaneous bacterial
peritonitis cannot be ruled out. Ascites is an
excess of fluid in the membrane lining of the abdomen (the peritoneal
cavity). Most cases of bacterial peritonitis occur as a result of
ascites due to chronic liver disease, or in kidney failure.
ASCITES - Fluid accumulation around the liver and other abdominal organs resulting from portal hypertension.
The rapid development of ascites, especially if observed in a patient with FHF accompanied by abdominal pain, suggests the possibility of hepatic vein thrombosis (Budd-Chiari syndrome).
Clinical signs and symptoms of biliary peritonitis include abdominal pain,
nausea, and vomiting. Spontaneous bacterial peritonitis is common in
patients with late onset hepatic failure. Compare:eMedicine -
Ventilation, Mechanical : Article by Ryland P Byrd, ...
Traumatic injury to the central nervous system (CNS) initiates an
autodestructive cascade of biochemical and pathophysiological changes
that ultimately results in irreversible tissue damage. Compare:
Esophageal Perforation, Rupture and Tears. See ESOPHAGUS ILLUSTRATION.
CompareMechanical Ventillation.
A-26 of the record documents a Blood Pressure of "78/70"
at 0235 hours, while
N-5 of the Nurses' Notes documents a Blood Pressure of "98/70"
at the very same time that is consistent with copious
error. The same record documents a body temperature above >37.0癈.
Fever has been defined as a body temperature elevated to at least 1癋
above 98.6癋 (37.0癈). According to the record the documented
temperature is just under <38.0癈.
Low blood pressure is a sign
of shock and can also contribute to further decreasing perfusion.
Hypotension = systolic pressure <90 mm Hg. Hypotension itself is a
late sign of hypovolemia or hypovolemic shock. As shock
progresses, the body temperature falls, respirations become rapid and
shallow. Urine output is reduced. Interventions: Blood volume must be
restored quickly to ensure a rapid return of oxygenated blood to the
perfusion of deprived tissues. It is also clear that this was NOT done.
A-16 documents a Blood Pressure of "163/117" at
0330 hours, while
N-3 documents a BP of "136/85" at the very same time.
(Suggests Hypertension Stage 2: *Compelling indications are high-risk
situations such as CHF, MI, CHD, diabetes, kidney disease, stroke.
Patients with chronic kidney disease or diabetes are treated to BP goal of
less than 130/80 mm Hg. Compelling indications have specific
medications). Blood pressure is usually considered normal if it's above
90/60 mm Hg, but can vary from person to person.
95. Further,
N-3 documents a "large amount of dilute urine" at 0330
hours, and also at 0425 hours as evidenced by the record at
N-2, and again at 0450 hours as evidenced at
N-1, suggestive of overly rapid "fluid overload" due to
overzealous and negligent IV infusion, and may be associated with
hyponatremia caused by impaired water excretion in the presence of
continued water intake. Hyponatremia is a condition known as
"water intoxication." It is the opposite of dehydration. Compare
Electrolyte Physiology. Excessive urine-output of very dilute urine can
also result in large free water losses and severe hypernatremic
dehydration. Compare: Fluid and Electrolytes. In contrast, an acute
adrenal crisis can present with vomiting, abdominal pain, and
hypovolemic shock.
Various edematous disorders, including heart failure and hepatic
Cirrhosis, are associated with hypervolemic hyponatremia.
NOTE: There is nothing on record to suggest close monitoring of
serum sodium (serum Na) levels. Irreparable harm can befall a patient when
abnormal serum sodium levels are administered or corrected too quickly or
too slowly.
Hyponatremia is the most common electrolyte disorder and is
associated with brainstem herniation due to cerebral edema.
Compare:.Electrolyte
disorders. and . Traumatic Disorders.
Note:
During
bacterial meningitis, brain edema can lead to increased
intracranial pressure ...
Brain herniation may also occur with untreated bacterial
meningitis., hematoma
is associated with a midline shift
Interestingly, hyponatremia is also associated with
dehydration, and patients with clinically significant hyponatremia
present with non-specific symptoms attributed to cerebral edema,
ie. anorexia, nausea and vomiting, lethargy, headache, obtundation, and
signs of brainstem herniation , including coma; they have fixed
dilated pupils, abnormal posturing, and respiratory arrest.
A-16 of the record also documents a
blood-pressure of 121/81 at 0400 hours, while
N-2 of the Nurses' Notes documents a BP of
112/57 at the very same time.
At 0352 hours the patient's blood-pressure was documented at
85/52, some 17 minutes later, as evidenced at N-2,
in which BP is inadequate for normal perfusion and oxygenation.
According to my research, at the point of loss of Blood Pressure the resulting end
organ injury is often irreversible ie., endothelium, lung, kidney liver,
etc. Any condition that compromises the host defense system increases the likehood of infection and sepsis. Compare azotemia, in which renal underperfusion cannot be rulled out. See also Endothelial Injury.
A-24 of the record documents a Heart Rate
of 154 brm at 0330 hours while the Ventilation Record
at
A-16 documents a HR of 126 at the
very same time, a significant difference.
From these records it is clear that nothing was done to bring the patients
blood-pressure under control in a timely manner and would have
resulted in permanent brain damage at that point. According to my
research, there would have been a loss of perfusion and autoregulation
with rapid drop in BP and it is also clear that when it did happen,
nothing was immediately done to correct it.
|
The Coroner's expert documents "decreased attenuation throughout both
cerebral hemispheres suggesting no cerebral perfusion", which
supports 1) a loss of cerebral perfusion associated with an untimely
response to a rapid drop in BP, and 2) inadequate oxygenation, despite
the fact that oxygem levels were returned to normal by compensatory
mechanisms, marked by a clinically evident inability to adequately
ventilate and/or oxygenate.
Compare: SHOCK - A clinical syndrome defined by a
state of profound and widespread reduction in tissue perfusion. ? Shock/
Hemorrhage/ Thrombosis Shock - A low-perfusion circulatory ... main organs
affected: brain, heart, lungs, kidney.
It is also of significance to note that adequate cerebral perfusion
must be restored within 3-5 minutes for complete neurological
recovery. It is also clear that this was NOT done.
104. The physicians Critical Care Note, a late dictation which
purports to have been dictated at 0420 hours on May 24th of
2000, seen at A-8
of the record documents "later that evening she rapidly deteriorated
and became unconscious without responding to verbal stimuli or painful
stimuli", while the record at
N-2 of the Nurses' Notes documents "attempts to pull away to
painful stimuli" at 0400 hours only 20 minutes earlier,
suggesting that she was indeed responsive. I was present at the time and
had asked the patient in the presence of her foster brother if she
could hear me to wiggle her toes, and she did, not once but twice.
In my opinion, she appeared to be more "paralyzed" than anything
from the given meds (with the exception of twitching or short
spasmodic contractions of the right leg), suggestive of the
"locked-in-state", for example, a condition in which a person is
conscious and able to think but is severely paralyzed due to nerve
paralysis or spinal cord compression, a condition mimiced by
high cervical cord lesions and severe drug-induced dystonias eg.
prochlorperazine. Paralysis as such can also be induced by chemical
restraint. Chemical restraint using phenothiazines may impair heat
dissipation, as well as lower seizure thresholds and potentially increase
cardiotoxicity. Due to the lowered threshold, abnormal firing
results in a "domino effect" of one neuron exciting
another which can exert significant influence on many organ systems at
once.
According to my research, multiple blood-clots in the CSF are the
initial cause of post-hemorrhagic ventricular dilatation and lysis of
clots. Compare:
Ventricular fibrillation
A-16 of the record was initialled by Helene Studholme and
Janice Chamaillard, jointly. The latter is the author of
N-1,
N-2, and N-3
of the Nurses' Notes and the co-author of
A-16 of the Ventilation Record, while 75% of that record
was authored by Helene Studholme, the Ventilatory Therapist.
What I take to be the Physician's Lab Record at
A-24 and
A-25 documents the patients vital signs at 5 minute intervals,
beginning at 3:15 hours. There is a complete absence of
record in several distinct columns, primarily relating to the patients
vital signs at the time of the intubation procedure, suggestive
of "edited lab notes" by the physician, after the fact,
such as to conceal iatrogenic (doctor caused) injury. As can be
seen after comparison of the records the credibility of the doctors and
nurses, the physician's records, the Nurses'Notes and the record as a
whole are severely impaired. As with discrepancies throughout the related
medical records it also seems clear that liver function abnormalities may
have been omitted altogether, or falsified by Dr. Jordan and his
accomplices and the fabrication of these records is just one aspect of
the Kirkland and District Hospital's corporate criminal conspiracy
to cover up the truth.
What I take to form a part of a continuous 2 page record at
A-24 and at
A-25 appears to have been printed on two separate printers.
Ironically, both pages are marked Page 1 of 1 (in lieu of Page 1
of 2, and 2 of 2), to rule out conformity or consistency. Further, when
both pages are superimposed one over the other and held over light, the
printed headings are misaligned. Further, the print sizes appear
to be slightly different. Similarly,
A-14 shows a misaligned margin suggesting a split or cut
in the page, with
A-13, and
A-27 presenting similarly.
The Cardiac Index at
A-18 documents the patient's Vent Rate at 129 bpm
at 0417 hours with heart and breath rate "increased", as
confirmed by the Sinus Tachycardia that is consistent with systemic
inflammatory response to clinical insult, or adverse event with
arrhythmias secondary to medications, including electrolyte
imbalances such as caused or worsened by medications,
suggestive of the Neuroleptic Malignant Syndrome (NMS). Shock,
and blood-loss, are also common causes and are associated with an
Abnormal Ventricular Electrocardiogram. See: Basis of ECG Diagnosis... Compare: Evidence of
Neuroleptic Drug-Induced Brain Damage in Patients: A partial, Annotated
Bibliography (CIRCARE).= CIRCARE. (CITIZENS FOR RESPONSIBLE CARE &
RESEARCH). Ref:
The Cardiac Exam: Auscultation Compare:
MVS Cardiac Auscultation
Auscultation of the Heart
THE MERCK MANUAL, Sec. 16, Ch. 197, Approach To The Cardiac
... (A
Practical Guide to Clinical Medicine)
Echocardiography
Compare: Myocarditis = inflammation of the heart in which sinus
tachycardia is the most frequent finding. Sinus Tachycardia is also
associated with cardiac toxicity, which can be traced to the drug
Stemetil. See also literature on Airway Management. Abnormal Rhythms.
Electrocardiogram (ECG)
REFERENCE: [1]
[2]
[3] [4]
[5] [6]
Compare the the ECG at A-18.
Each drug tends to have a signature, meaning a typical pattern of
injury. In the case of phenothiazine type drugs, this pattern of injury closely mimics acute viral hepatitis, clinically, biochemically and
histologically.
Identifying Drug-Induced Changes in Electrocardiogram - features
individuals whose ECG's have been altered due to multiple
pharmacologic agents.
The same record documents an unconfirmed ECG that is consistent
with heart failure, according to one MD who sent me an eMedicine
Case Diagnisis on Exertional Fatigue, by Michael E. Zevitz, MD who is
Clinical Assistant Professor, Department of Medicine, Chicago Medical
School. All aspects of that document are now currently being studied for
comparative analysis. Earlier on, another MD from South Africa
had also sent me an e-mail suggesting Azotemia. Preliminary
findings suggest that both of these doctors are right of course.
Sinus Tachycardia results from increased automaticity of the SA
node, for instance, due to increased sympathetic stimulation of the
heart, fever or cardiac toxicity. That the patient's
Heart Rate had soared to 174 bpm at the point of intubation
should also be born in mind. Additionally, a wound or injury
caused suddenly = Acute Trauma.
Pathologic Tachycardia (abnormally rapid heartbeat over 100
beats per minute) accompanies anoxia (lack of oxygen to
tissues) such as caused by anemia, congestive heart failure,
hemorrhage or shock, which can be responsible for a drop
in the patient's blood pressure and decreased perfusion to the
patient's coronary arteries. An abnormally fast heart rate could
be due to injury, heart disorders, low blood-oxygen (hypoxia),
hypokalemia, hypoxemia, hypovolemia, or to a panic
attack, ie. the panic factor from clinical situations or
iatrogenic insult. Compare:
Panic disorder It is also a normal response to pain,
and is associated with heart failure Compare the Laboratory
Findings. Compare: Arrhythmia Recognition. Arrhythmias, Approach to Common
Problems - Sinus Tachycardia - Differential. Arrhythmia Recognition The
EKG Measures the Body's Electrical Activity. See:
Anemias
The same report documents an "inferior
ischemia", a sign of decreased oxygen supply to vital
organs suggestive of arterial occlusion, for example,
resulting in reduced or poor blood-flow which can induce cerebral
tissue ischemic injury by producing "mid-line shift " and
" herniation" .Thus "Ischemia" is an insufficient
supply of blood to an organ, usually due to a blocked artery.
Decrease or blockage of blood flow to an organ or
tissue = Ischemia. Ischemia leads to clinical event called "stroke".
Compare The Pathophysiology of Hemorrhagic Shock - A clinical syndrome
resulting from decreased blood and oxygen perfusion of vital organs
resulting from a loss of volume.
Reduction in blood flow (relative ischemia) impairs O2 delivery and
causes cerebral hypoxia.
The same record documents an abnormal ST&T wave segment on ECG
that is consistent with adverse effects of the drug Stemetil.,
as reported in the Compedium of Pharmaceuticals and Specialties (CPS)
2003.
Interestingly, the patient's age was falsely documented at "55
years" when in fact she was only 41 years of age,
suggesting that this Chart may have been fraudulently replaced with that
of another more elderly patient. Alternatively, it goes to the credibility
of the remainder of that Chart, and the credibility of the remainder of
the physician's records. Findings suggest that with older patients,
"the incidence of adverse reactions may be greater in patients over 55
years of age, since the half-lives of antipsychotic medications are often prolonged".
The fact that age 55 showed up on
the chart of a 41 year old patient is seen to be significant,
suggestive of a possible secret and fraudulent reporting of adverse
events associated with the drug Stemetil.
The physician's Lab Work Summary at
A-19 documents the charting of a course of HEMATOLOGY and
Coagulation. It documents a
FIBRINOGEN level of 4.67 H (the normal range is 2.00-4.00),
increased in response to injury, hypertension, and trauma.
Fibrinogen is a
protein which is synthesized by the
liver. Fibrinogen decreases with liver disease, due to
decreased hepatic synthesis. However,
Fibrinogen may be normal or even elevated until late stages of hepatic
disease. There is a significant correlation in the white blood-cells and
plasma fibrinogen in thrombotic stroke. Fibrinogen allows blood to
clot more easily. Compare: Hypertension and Risk in Ischemic Heart Disease
FIBRINOGEN LEVEL CARE GUIDE INFORMATION FIBRINOGEN LEVEL
-
The same record at
A-19 documents a D-dimer test level of 1000 H
(<500), including hematological findings in the High (H) and
Low (L) ranges suggestive of pathology associated with blood
disorders ".
According to my research, high levels of fibrinogen can cause abnormal
arterial "clotting". Serum fibrinogen levels in a safe
range is <300 mg/dL.
Fibrinogen acts to promote platelet aggregation - clumping
together of platelets or cells in the presence of fibrinogen at the
site of injury resulting in diminished blood flow and delivery
of oxygen to the body, i.e. arteries, heart,
brain, and kidneys in which thrombosis and organ damage
occur because of excess platelet aggregation. Thus excess fibrin clots
capture the platelets and produce thrombosis with impaired organ perfusion. Abnormal platelet aggregation is often the trigger for a heart attack.
See:
Platelet aggregation test
D-dimer suggests "thrombosis" (blood clotting) and is the
confirmatory test in Disseminated Intravascular Coagulation (DIC) . Disseminated intravascular coagulation (DIC), previously considered a specific disease, is now considered part of a pathophysiologic process involving excess coagulation such as seen in sepsis and related disorders, e.g. systemic inflammatory response syndrome (SIRS), or multi-organ dysfunction syndrome.
Thrombosis= Formation of a clot(s) within vessels of the brain or neck.
PATHOLOGY EL: Hemostasis and Thrombosis, Pathology
[PDF]
THROMBOSIS CURRICULUM
Format de fichier: PDF/Adobe Acrobat -
Version HTML
"Over two thirds of all strokes are
due to thrombosis."
Trauma, particularly brain injury, is associated with DIC
(Levi & Ten Cate, 1999).
Compare BRAIN DAMAGING NEUROLEPTIC DRUG in which poisoning or drug intoxication can cause deep physiologic depression that resembles and can mimic brain death.
The aPTT = activated Partial Thromboplastin Time, a test used to
determine the efficacy of various clotting factors used in the
diagnosis of coagulation
disorders documents the therapeutic range for Heparin therapy
at 60-100 seconds (23-35 is the normal, >60 seconds=Panic)
and is elevated in 90% of those with coagulopathy, an increased
bleeding tendency due to decreased hepatic synthesis of clotting
factor, i.e. with prothrombin ( a protein involved in clotting, most
commonly prolonged by vitamin K deficiency and liver disease) time
increased. The time of that assessment was documented at 0400 hours.
See:
Bleeding time
Notably, coagulopathy in severe
Sepsis is commonly associated with multiple organ
dysfunction. Sepsis as the host response to infection,
involves a series of clinical, hematological, inflammatory and metabolic
responses that can ultimately lead to organ failure. Severe sepsis is
typically associated with activation of the coagulation system,
leading to deposition of thrombin in the microvasculature = Interaction of
coagulation and inflammation. Coagulation system and platelets are
fully activated in uncomplicated sepsis. Compare:
Idiopathic thrombocytopenic purpura
Keywords: Activated Protein C, antithrombotic, coagulation, endothelial
cells, fibrinolysis, inflammation, organ dysfunction, sepsis.
The same record documents the patients Blood-Cell Count beginning
with the WBC's or White Blood-Cells (the normal is
4.0-11.0), also known as the Leukocytes with a count of
22.4 #pH, increased to more than double the normal range, and is
associated with allergic response, presenting in this case with
what I take to be an abnormally high alkaline pH (alkalosis).
A pH above 7.0 is alkaline; the higher the number, the stronger
the alkali. See:
Blood gas analysis Compare Alkaline
phosphatase test
Compare:Blood/Gas Profiles
Alkalosis is a condition of excess base (alkali) in the body fluids. 6.2
CHEMICAL CLASSIFICATION OF CAUSES OF CHANGES IN BLOOD pH Compare: Arterial
blood gas analysis.
Metabolic alkalosis. Compare:
Respiratory alkalosis
The White Blood-Cells (leukocytes) are also elevated with
dehydration, hyperviscosity secondary to dehydration, and
infection causes. It is the most common form of
Leukocytosis. Leucocytosis is an increase in the number of
white blood-cells in the blood. It is a common feature of
inflammatory reactions, particularly those caused by bacteria.
The type of leucocyte increasing in number is dependent on the stimulus
type and chronicity; subtypes include: neutrophilia, basophilia,
eosinophilia, lymphocytosis, monocytosis.
Leukocytosis also can occur in
Intestinal obstruction, strangulated hernia, and leukemoid reactions (a reaction resembling leukemia, but is actually due to other conditions such as infections).
Reference:MEDLINEplus Medical Encyclopedia: WBC count. Compare
LABORATORY FINDINGS - Shock
The record at
A-19 documents a Lymphocyte Count of 2.0 L (low) suggestive of "Lymphocytopenia"
in which LYMPHOCYTES are reduced with nutritional deficiency, infection or
an exhausted immune system - a state of immunodeficiency characterized by
a reduction of the number of T-lymphocytes, unlike absolute lymphocytosis
in peripheral smears w/ seen in malignant disease. Further, a decreased percentage of lymphocytes may indicate Sepsis.
Compare: Autoimmune Hepatitis, a disease in which the body's immune system
attacks liver cells. This causes the liver to become inflamed (hepatitis).
A person with autoimmune hepatitis has autoantibodies circulating in the
blood-stream that cause the immune system to attack the liver. This
disease is associated with other autoimmune diseases, including hemolytic
anemia. Compare: Non-immune hemolytic anemia caused by chemical or
physical agents: non-immune adverse reactions. Autoimmune disorders
develop when the immune system destroys normal body tissues. This is
caused by a hypersensitivity reaction. hemolytic due to toxic agents, ie.
infection, bacterial lysins. Compare Drug-induced immune hemolytic anemia.
The word "auto" is the Greek word for self. The immune system is a
complicated network of cells and cell components (called molecules) that
normally work to defend the body and eliminate infections caused by
bacteria, viruses, and other invading microbes.
In toxic shock, profound but transient lymphocytopenia associated with
marked leukocytosis was the most striking laboratory finding and one not
previously emphasized in the literature. S. aureus was isolated from sites
of soft-tissue infection, the or the endocervix in all except one case.
123. Lymphocytopenia causes may also arise from accelerated destruction of
T cells or other syndromes associated with depletion of lymphocytes . Low
numbers of lymphocytes may be seen in different diseases such as
hepatitis, lymphoma, or AIDS. Compare: Hepatitis Central, Lymphocytes.
Further, signs of toxic shock syndrome when T cells are absent: S. aureus
shock in immunodeficient patient's.
Interestingly, iatrogenic lymphocytopenia is caused by cytotoxic
chemotherapy and radiation therapy, marked by a reduction in the absolute
number of T cells. Lymphocytes are the most sensitive to whole body
radiation and their count is the first to fall in radiation sickness. The
number of lymphocytes declines within the first 12 to 48 hours after
exposure. This is followed over several weeks by a decline in the number
of other blood-cells. The decline in lymphocytes is one of the best early
signs of the severity of the radiation injury. The Immune System and
Radiation - Hanford Health Information ... THE MERCK MANUAL, Sec. 20, Ch.
278, Radiation Reactions And ... Sec. 11, Ch. 135, Leukopenia And ...
The same record documents an Absolute Lymphs (Lymphocyte) Count of 124.
0.4L (low), suggestive of "ascites", a sign of chronic liver disease, or
evidence of cardiac failure, due to fluid build-up in the abdomen in which
liver disease is the most common cause. Among conditions that contribute
to ascites development include hepatitis and heart or kidney failure. The
main pathogenic factor is sodium retention. Compare: Ascites, Symptoms,
Signs, and Diagnosis. Clinical review Underlying condition causes of
Ascites: heart, lung, and liver disorders.
What are the signs and symptoms of the condition?. As can
be seen, abdominal pain is at the top of the list with causes of the
condition traceable to radiation therapy, side effects of which include
bowel obstruction, and http://atoz.iqhealth.com/HealthAnswers/encyclopedia/HTMLfiles/3163.html>heart
disease, or congestive heart failure. Congestive heart failure, also known
as CHF, is a condition in which a weakened heart cannot pump enough blood
to body organs. Since the pumping action of the heart is reduced, blood
backs up into certain body tissues.
Corticosteroids, such as prednisone, can reduce damage to healthy organs.
None was prescribed nor given by the patient's oncologist, Dr. Prichard,
nor any other doctor who attended to this patient while she was under
their care.
If the ascites is due to liver disease the fluid may be clear to
"yellowish", uninfected and have a low cell count. If bacterial infection
is present in ascites this may suggest spontaneous bacterial peritonitis
in which abdominal pain is a prominent finding. If peritonitis is not
treated promptly and effectively multisystem organ failure occurs rapidly.
Liver function tests, including clotting profiles were NOT done in a
timely manner.
Further, the same report documents the Neutrophils (also known as
granulocytes) with a count of 92.0 H (normal 47.0-77.0). Neutrophils are a mature white blood cell that fights bacterial infections. Neutrophil accumulation in tissue is another hallmark of inflammation and is
associated with a variety of pathological conditions. The same record also
shows Absolute Neuts of 20.0 H (normal 1.3-6.7), and is increased in
response to acute infections (bacterial or viral), blood-toxicity and
hemorrhage. In fact all of the relevant literature suggests that neutrophilia typically occurs because of inflammation and infection, especially pyogenic bacterial infection, as is the case here. Leakage of oxidative metabolites from the neutrophils into the
tissue can potentiate the inflammatory process.
Toxic change in neutrophils is not necessarily associated with "toxemia".
The term derives from the fact that these abnormalities were first noticed
in human patients with gram negative sepsis and endotoxemia. Toxic change
in neutrophils can be associated with inflammation of any cause if severe
enough to intensely accelerate neutrophil production.
Leukocytosis (especially neutrophilia) indicates systemic infection.
Study of Information : Endotoxins and other bacterial products appear to
cause direct cellular injury while eliciting cytokines that attract
neutrophils, which enhance (hypersensitization, brain edema (during
bacterial meningitis, brain edema can lead to increased intracranial
pressure), and hypercoagulability with vascular inflammation from
endotoxin) the inflammatory effect >>endotoxin shock. It has been
well-described in the scientific litererature that the presence of
endotoxin is common in rapidly dividing bacteria at sites of localized
infection and abscesses in the gut.
The HCT (hematocrit) shows a count of 0.361 L (low). A low hematocrit is
referred to as being anemic. There are many reasons for anemia. Some of
the more common reasons are loss of (traumatic injury, surgery, bleeding
colon cancer), nutritional deficiency (iron, vitamin B12, folate), bone
marrow problems (replacement of bone marrow by cancer, suppression by
chemotherapy , kidney failure). An abnormal hematocrit = sickle cell
anemia. Signs of blood loss, such as shock, hypotension, and a falling
hematocrit level are associated with liver trauma. One caveat: bleeding
may be severe even when the hematocrit is normal since it can take 24 to
72 hours to reflect the volume loss.
129. HCT - Hematocrit is thus the measurement of the percentage of red
blood cells in whole bloodwith a reduction suggestive of anemia. Normal
Female Range is 37-47%. Anemia is present when hematocrit is <37% in
women.
Ref: HCT Fact Sheet
130. The RDW (Red Blood-Cell Distribution Width) shows a count of 18.4 H
(normal 11.50-16.8) increases before MCV (Mean Corpuscular Volume) becomes
abnormal suggestive of anemic
hemoglobinopathy.
A-30 of the record documents an Arterial pO2 of 129.0 H (normal
75-100).
Increased arterial pCO2 (hypercapnea) causes cerebral dilation
CO2 diffuses through blood-brain barrier into the CSF to form H+ (via
carbonic acid) which then causes the vasodilation
Deficient oxygenation of the blood (<90 mm Hg arterial pO2). Decreased
arterial pCO2 as occurs during hyperventilation causes cerebral
vasoconstriction, decreased blood flow, and cerebral hypoxia.
1) Reduction in blood flow (relative ischemia) impairs O2 delivery and
causes cerebral hypoxia. 2) Unconsciousness results after only a few
seconds of oxygen deprivation. Compare: Cerebral Blood Flow
View HTML
See: Metabolic effects of increased Arterial pO2
131. Further, RDW is a standard part of the complete
blood
count. (The Mean Corpuscular Volume (MCV ) test is usually
used to determine what type of anemia a person may have. If elevated, it
may indicate anemia from vitamin deficiency such as Vitamin B12 or folic
acid. If it is below normal, it usually indicates anemia from iron
deficiency.)
132. Mean Corpuscular Volume (MCV) Increased with
1. Vitamin B12 Deficiency
2. Folate Deficiency
3. Immune Hemolytic Anemia
4. Liver disease
The same report documents a
Platelet count of 544 H, what is Thrombocytosis
, increased with coagulopathy
(platelet coagulant activities) or platelet aggregation (cohesion of
platelets to each other forming clumps), may also indicate a benign reaction to an infection, surgery, blood vessel injury, or certain medications. Further, thrombocytosis can cause bleeding or thrombosis. Platelet count (marked thrombocytosis common in second week of toxic shock-like syndrome illness).
High platelet count (over 500,000) may predispose to either clotting or hemorrhage. Platelets are thus cells that
form the primary mechanism in blood-clots.
See: Table 1: Causes of thrombocytosis.
Increased numbers of platelets in the peripheral blood =
Thrombocytosis. In Toxic Shock, thrombocytosis
(rather than
thrombocytopenia)
is common. Compare
Thrombocytopenia
Platelets (also known as thrombocytes) coagulate the blood. Platelets plug
bleeding capillaries and vessels. With infection, or when the body is cut
or otherwise injured, white blood cells (WBC's) rush to the site as the
first line of defense. Platelet aggregation contributes to the coagulation
cascade with activation, i.e. esophageal perforation or other iatrogenic
trauma/procedures and can lead to DIC and hemorrhage. Platelets are also
elevated with drug-reactions (toxicity & brain damage by disrupting the balance of body & brain metabolism), including dehydration. Dehydration from any
cause increases blood viscosity and raises the risk for thrombus
formation.
A diminished number of platelets (below the lower limit of normal) is
called thrombocytopenia and an elevated number (above the upper limit of
normal) is called thrombocytosis. WBC . Increased
. See
Thrombocytosis
Platelet Count May Predict HCV Liver Disease Progression
Larger platelet volume also indicates younger and more active platelets of
recent onset volume (equivalent of MCV for Red Cells) in the Complete
blood Count. See Blood Tests: Complete Blood Count Tests: Complete Count
A-19 documents a Monocyte Count of 3.0 with a marked decrease as
evidenced by ABSOLUTE MONOs (monocytes) with a count of 0.60 (normal
1.0-5.5) with a reduction [<0.60] indicative of a anemia. MONOCYTE: A
variety of blood cells (white). The normal range for the monocyte count is
200 - 950 /礚. A decreased lymphocyte count = lymphopenia may be caused by
chronic infections, severe stress (Hyperadrenocorticism), and kidney
failure. An increase in monocytes is typically observed during the phase
of recovery following many infections, including hematologic neoplasms.
Compare: DRUG INDUCED LYMPHOPENIA associated with -
1. Aplastic Anemia (a disorder in which the bone marrow)
2. Lymphocytic Anemia
3 - anemia, or a low red cell blood count
4 - bleeding problems due to poorly working clotting cells, called
platelets
5 - loss of normal white blood cell function, which
increases the risk of infection 6 - a need for red blood cell transfusions
A decrease in the number of circulating monocytes may be seen with:
Innunodeficiency syndrome, including congenital (DiGeorge syndrome, etc)
and acquired (AIDS) conditions, Neoplasia, including Hodgkin's disease,
non-Hodgkin's lymphomas, Radiation therapy, Chemotherapy/Antineoplastic.
Monocytes are considered the bodys second line of defense against
infection. In cancer, leukemia or neoplasms the moncytes become "elevated
or what is called Monocytosis. An abnormal increase in the number of
monocytes in the circulating blood.", to rule out Metastasis. Toxic
substances can also injure monocytes.
Hemoglobin is the protein inside red blood cells that carries and provides
the main transport of oxygen and carbon in the . It is composed of "globin",
a group of amino acids that form a protein and "heme", which contains
iron. It is an important determinant of anemia (decreased hemoglobin) or
poor diet/nutrition or malabsorption. Liver disease can lead to a shortage
of hemoglobin. The hemoglobin test is used to check if there is
enough oxygen in the body tissues. See
Hemoglobin test
The record documents a Glucose Random of 13.2 H (normal
4.1 - 7.8), a condition in which the amount of blood glucose (sugar) in
the blood is higher than normal suggestive of hyperglycemia, a metabolic
disorder, and is associated with renal pathophysiology, such as clinical
diabetes, for example, and may be associated with functional renal
failure, ie. hepatorenal syndrome. If levels of serum Glucose
Randon are too high, the person is hyperglycemic, and may need insulin.
See
Creatinine test
Three separate types of
acute
kidney failure have been identified: pre-renal, intrinsic,
and postrenal. Pre-renal ARF occurs when low blood circulation leads to
significantly low blood flow, and is often caused by dehydration, shock or
low cardiac output (as seen in heart failure). Glucose Test.
What do abnormal results mean? Additional conditions under which this test
is performed include Acute adrenal crisis. Adrenal crisis occurs if
adrenal insufficiency is not adequately treated, a prominant finding in
Distributive (septic, anaphylactic, neurogenic, and adrenal insufficiency
mediated) Shock. Acute adrenal crisis is a medical emergency caused
by a lack of cortisol (a steroid hormone secreted by the outer portion, or
cortex, of the adrenal glands) - it has marked effects on carbohydrate
metabolism and is an immunosuppressant.
Risk factors for adrenal crisis include physical stress such as infection,
trauma or surgery, adrenal gland or pituitary gland injury. Patients may
experience lightheadedness or dizziness, weakness, sweating,
abdominal pain, nausea and vomiting, or even loss of consciousness.
A-20 of the Laboratory Discharge Summary documents a Serum
Potassium level of 3.4 L (low) suggestive of hypokalemia
(a decrease in the serum potassium concentration below 3.5 mEq/L caused by
a deficit in total body potassium stores or abnormal movement of potassium
into cells) which leads to an electrolyte imbalance as caused by ongoing
or severe fluid losses form the GI Tract , i.e., such as from vomiting and
malnutrition which can lead to weakness,
fatigue and cardiac problems. Anything below 3.5 creates a
serious risk of cardiac arrhythmias leading to cardiac arrest. In
addition, loss of potassium and volume contraction from vomiting
potentiate metabolic alkalosis.
Potassium plays a crucial role in the body, regulating heart beat and
other critical functions. Low levels of potassium--known medically as
hypokalemia (HI-poh-kah-LEE-me-uh) can be dangerous and potentially fatal.
Thus hypokalemia can commonly result from the loss of potassium through
dehydration, vomiting, and gastric suction, and is also associated with
hyponatremia. See: Potassium Metabolism.Compare: Iatrogenic Hypokalemia.
Search: Metabolic Toxic Electrolyte Imbalance
Hypokalemia: Abnormally low potassium concentration in the blood ; it may
result from excessive potassium loss by the renal or the gastrointestinal
route, from decreased intake, or from transcellular shifts. It may be
manifested clinically by neuromuscular disorders ranging from weakness to
paralysis,
by electrocardiographic abnormalities (depression of the T wave and
elevation of the U wave) by renal disease, and by gastrointestinal
disorders.
The most common problems associated with reduced potassium levels are
hypertension, congestive
heart failure, cardiac arrhythmias, depression, and
fatigue. A variety of conditions can cause the loss of potassium from the
body. The most common of these conditions are vomiting, diarrhea, and
other gastrointestinal problems, such as Constipation. See: THE MERCK
MANUAL, Sec. 3, Gastrointestinal Disorders . Medications can also cause
depletion of potassium. Hypokalaemia is commonly caused by medication.
Compare: Electolyte Imbalance -Hypokalemia and hyperkalemia. Low potassium
- Hypokalemia increases the resting membrane potential of cells, resulting
in muscle weakness, impaired concentrating ability, polydipsia and
arrythmias. It is usually due to gastrointestinal or renal losses of
potassium. Hypercalcemia
No serum Potassium replacement was ordered or administered. It is not
known what the patient's potassium level was at the time of her admission.
No lab tests were performed soon enough to verify or treat accordingly.
Signs and Symptoms of potassium deficiency include cardiac arrhythmia,
muscle pain, general discomfort or irritability, weakness, and paralysis.
In my opinion the ED physician, Dr. Spiller should have ordered monitoring
by electrocardiogram and done appropriate testing at the onset, but failed
in his duty of care to do so.
The same record at A-20 documents a Creatine Kinase (CK): 40 - normal range is 22 to 198 U/L (units per liter). CK tests are used to evaluate neuromuscular diseases, but CK levels don't always reflect the level of functional impact on the individual. CK is an enzyme normally found in the brain, heart and skeletal muscleElevation of CK-I may be seen in stroke, extreme shock, or brain tumor. In females, total CK should be 10-79 units per liter (U/L). If elevation of CK may be seen in stroke, extreme shock , or brain tumor, why would the CK show normal???
Symptoms of an acute toxic reaction include agitation, tachycardia, hypertension, dilated pupils, trismus, and sweating, whereas the more severe cases may be characterized by hyperthermia, disseminated intravascular coagulation (DIC), rhabdomyolysis, and acute renal failure. In more severe cases, elevated creatine kinase levels are often present, with levels as high as 122,341-555,000 IU/L being reported. Creatine is also decreased with renal perfusion (hypotension, dehydration, CHF), and urinary tract infection.
CAVEAT:
The Coroner alleges "multiple metastatic brain tumors", and no drug reaction. Why then is there a normal CK and so much evidence to the contrary?
The ambulance call report seen at
N-7, of the Nurses' Notes documents that the patient was intubated
and vented and that she was seen to be stable but that she appeared to be
"pale, dry and cool," clinical manifestations of adrenal
insufficiency, or HYPOVOLEMIC SHOCK: fairly reliable signs of compromised
perfusion. Compare TSS Pale ?Whitish color indicates hypo
perfusion (shock), is a medical emergency. Compare:EM guidemap - Upper GI
bleed, including ANS and Shock. See:
Upper GI examination
Compare Shock Syndromes in which vasoconstriction, pallor, cold
peripheries all point to circulatory failure.
Hypovolemic shock occurs when there is insufficient or inadequate
blood circulating throughout the body. The most common causes of
hypovolemic shock include hemorrhage from any source, or blood volume
depletion related to dehydration. Hemorrhage is defined as a loss of from
any cause. Common causes of hemorrhage include traumatic injury, surgery
and gastrointestinal bleeding. Compare: Understanding Shock Syndrome
There is an X mark in the box pertaining to allergies NKA
suggestive of NO KNOWN ALLERGIES, and a further notation claiming "Dr.
now suspects that cancer has gone to the brain". The same report
documents "intracranial bleed" that is inconsistent with the
"coffee-ground emesis" (bloody emesis) documented in the Nursing
Notes and on the Ventilation Record on or about the time that the patient
was intubated.
The same report also documents " pulses x 4 good", including "head/neckOK";
"chest OK;" "abdomen OK"; pelvis OK; and "extremities OK." Further,
there is nothing on the Ambulance Call Report with respect to the bloody
vomitus" or "COFFEE-GROUND EMESIS" documented in the Nurses' Notes.
Compare: Castrointestinal Bleeding See
MedlinePlus Medical Encyclopedia: Vomiting blood
The very same report documents a "Nature Code 0" (No Code = No Care) or
hospital shorthand for "bed shortage", Code Zero, including a "withdrawal
of life support" from a critically ill patient or DNR "do not resuscitate
order" issued against family wishes, and without lawful consent. The time
of that report was documented at 0620 hours on May 24th of 2000, only
hours before the patient's death. Do not resuscitate (DNR) means no chest
compressions, no defibrillation, no assisted ventilation, no endotracheal
intubation, and no cardiotonic medications. The same record documents a
Code 3.3 "Withholding Treatment".There was NO "Do Not Resuscitate" order
on the patient抯 health record nor had there ever been a designated agent
who declined continued resuscitation on behalf of the patient. The
decision to terminate Arlene Berry was made solely by Dr. Edward Henry
Jordan and his accomplices.
In Dr. Jordan抯 FPC letter to the College of Physicians and Surgeons of
Ontario dated November 28, 2000 he writes 揑 discussed the situation with
family members and a decision was made to intubate Ms. Berry? It seems
absolutely clear, that the doctor (as in this case) knew of the need for
emergency care and after ordering it, canceled it and "waited" for her
death after withdrawing life support from this critically ill patient.
This is further reflected in A-1 of the medical where where Dr. Jordan
writes "She died several days later with numerous metastatic lesions to
her brain". It would have taken the patient several days to die without
life support. Notably also, the body of the deceased was not immediately
returned to Kirkland Lake. They had withheld it for several days. Arlene
Berry was made to suffer a death by dehydration - .
With dehydration, dehydrated blood becomes thicker and sluggish, and
therefore, more prone to clotting. Dehydration interrupts blood flow which
causes clots, cutting off the supply of oxygen to various parts of the
body such as kidney resulting in kidney clots.
Death by dehydration is accompanied by fever, convulsions,
retraction of the eyes into their orbits, drying out of the mouth and
skin, among other things. before death results several days later in a
cruel and violent death. The element of duty is now satisfied because once
the physician undertook care for the patient the physician had a clear
duty to exercise reasonable care toward the patient. According to Dr.
Jordan "On May 23, 2000, Ms. Berry was seen in the E.R. and admitted by
Dr. Spiller with symptoms suggestive of metastatic CA of the brain." The
same record documents that the patient complained of being "cold". She had
the chills and so the nurses provided her with extra blankets. She was not
very communicative due to extreme somnolence (fatigue) and stated that she
was "very tired".
The same record at
N-6 documents family in at 1915 hours and there is also a
notation with respect to "emesis of ^ 100cc yellowish fluid", what
is bilious vomit. Who the hell do these asshole doctors think they are?
According to the Nurses' Notes at
N-1 of the record the patient was given Gravol 50 mg x 10 by
paramedics at 0620 hours, while the record at
N-7 with respect to medications documents "See Nsg Notes".
Notably, Dimenhydrinate (Gravol) is contraindicated in chronic lung
disease and has also been reported to "mask the presence of underlying
organic abnormalities or the toxic effects of other DRUGS."
The complications of acute liver failure are numerous and include: sepsis, gastro-intestinal bleeding, cerebral edema, renal and cardiac failure. Bleeding varices may also result from portal vein thrombosis. See Deep vein thrombosis Compare: Vascular Disorders of the Liver / L.J. Worobetz. DRUG-Induced liver disease can mimic viral hepatitis or biliary tract obstruction as well as any other type of liver disease.
Compare: Portal-systemic encephalopathy in non-cirrhotic
patients. See:
Liver encephalopathy See
Gastroenteritis
Disseminated Intravascular Coagulation is associated with sepsis,
especially with "gram-negative" bacteria or fungal infection. DIC
leads to both bleeding and thrombosis.
. Respiratory failure results when the physiological capacity of the
respiratory system is less than the body's physiological requirement and
can be defined when the arterial PO2 (PaO2) is less than 60 mm Hg or the
arterial PCO2 (PaCO2) is greater than 45 to 46 mm Hg. Clinical Features of
Respiratory Failure: Pulse oximetry estimates the O2 saturation of the
hemoglobin, which in this case is inconsistent with much the blood-work.
A high CO2 level is always associated with hypoxia. A low hemoglobin usually indicates the person has anemia.
Gastrointestinal bleeding should be controlled if possible and purged from
the gastrointestinal tract.
Given the known effects of penicillin and penicillin-like drugs the
possible effects of concomitant administration of toxic neuroleptic agents
such as prochlorperazine in the circumstances, Arlene Berry may have gone
into shock, or cardiac arrest or both.
Following her transfer to Sudbury on May 24th of 2000 Arlene Berry was was
returned to Kirkland Lake several days after family had been notified of
her . Her eyes were sunken in appearance, with swelling and distortion of
the face, eyes, and mouth (lips), as was the case, marked by elongated
facial furrows (deep wrinkles in the skin) with a rashlike redness (resembling a sunburn)
and swelling to the face in the area just below the right eye suggestive
of massive edema (swelling from excessive accumulation of serous fluid in tissue) that was evidenced by all who attended Arlene
Berry's wake and funeral. Compare fixed drug eruption,
a circumscribed skin lesion as caused by continuing or repeated exposure
to a sensitizing drug. Drug eruptions are common iatrogenic diseases. Compare: angioedema.
Artificial ventilation and oxygen should have been prioritized and
promptly administered to include withdrawal of the offending drug, but
were NOT. Instead the patient was seen to be propped up in the arms of two
errant nurses (not a recovery position) gasping for air, with only a
plastic oral airway in her mouth for quite some time. There was
consternation among the nurses - the horrific look on their faces said it
all.
When Dr. Jordan finally showed up in the small hours of May 24, 2000,
precious moments that followed were not taken up with measures to save his
patient's life, but rather ways to accelerate her demise. He even proposed
a "DNR" (do not resuscitate order) and asked us bluntly if we would prefer
to let "nature take its course". The family was not impressed and so
insisted that she be placed on "life support".
Obviously, Dr. Jordan did not support the use of aggressive
interventionist treatment to keep alive someone he had already injured,
for to give treatment to remedy a wrong would expose the fact that
mistakes were made.
Arlene Berry was seen to be the victim of a botched intubation
procedure which could have saved her life but instead resulted in possible
internal injury and internal bleeding (e.g. esophageal or lethal
gastrointestinal perforation associated with careless instrumentation),
due to "malpositioning" of the endotracheal tube which triggered a quick
deterioration of her condition; one full hour went by before the error was
discovered and the endotrachial tube pulled back.
REFERENCE:
1) eMedicine - Esophageal Perforation, Rupture, and Tears 2) eMedicine -
Esophageal Perforation, Rupture and Tears : Article Excerpt by: Martin J
Carey, MD, MPH, BCh 3) Esophageal Perforation, Rupture and Tears from
Emergency Medicine / Gastrointestinal
163. According to the medical record the intubation procedure was
performed by Dr. Jordan, assisted by Helene Studholme, a Respiratory
Therapist at the Kirkland and District Hospital.
164. Following the bungled intubation, rather than confine clotting of the
blood to the site of the injury, or perhaps due to his mindless and
promiscuous use of inappropriate lab settings or other negligence it seems
clear that Dr. Jordan triggered a Coagulation Cascade of spontaneous
slugging of the sending numerous % blood-clots" to her brain, resulting in
herniation or intracerebral hemorrhage. The levels of Fibrinogen, and D-dimer
charted in the medical record for May 24, 2000, together with "evidence
based medicine" criterion confirms not only the the Disseminated Intravascular
Coagulation, but also activation of the coagulation cascades, an essential component in the development of multi-organ failure and is associated with Sepsis. Sepsis results from a generalised inflammatory and procoagulant response to an infection. Inflammation has long been known to be part of the body抯 response to infection. Evidence is accumulating that coagulation is part of that response. See:
Fibrinogen test
MEDLINEplus Medical Encyclopedia: DIC (disseminated intravascular ...
Postgraduate Medicine: Disseminated intravascular coagulation -
Disseminated Intravascular Coagulation (DIC) Profile, ... Acquired
Disorders of Coagulation MEDSTUDENTS-GASTROENTEROLOGY THE MERCK MANUAL,
Sec. 13, Ch. 156, Bacteremia And Septic Shock. Adrenal Pathology
Section 1: First Principles of Gastroenterology
Chapter 14 - Section 13: First Principles of Gastroenterology See:
Septic shock
165. At the first meeting with the coroner held at the OPP Detachment in
Kirkland Lake, Ontario in July of 2001, Dr. Barry A. McLellan, the
Regional Coroner admitted to family that there was "no evidence on record
of metastatic cancer".
At a subsequent meeting between family and the Regional Coroner, Dr.
McLellan provided us with a view of Arlene's prior CT scan that was done
in Timmins, Ontario on or about the 16th of March of 2000. I had
accompanied Arlene to the Timmins and District Hospital on that date. A
special contrast medium (dye) was injected into a vein before the CT scan
was done. "NO clinically detectable metastasis was found". A
mediastinoscopy to directly see the organs inside the mediastinum, with
mediastinotomy to collect tissue sample had been done on that date. The
result of that testing proved "NEGATIVE". Mediastinoscopy is also used to
stage lung cancer, especially when enlarged nodes are seen on chest x-ray
or CT scan. Further, contrast medium-induced nephrotoxicity (CMN) is a
common form of iatrogenic acute renal failure. The mechanism for CMN is
not understood, but renal insufficiency, dehydration, and congestive heart
failure are risk factors. See: Computed
tomography scans
With respect to the initial CT scan hereinbefore mentioned, according to
the Coroner's expert "in the right occipital region there is a spot
that measures less than 1 cm that is consistent in appearance with either
a small hemorrhage or perhaps a small metastatic tumor". He could
only speculate. It is also consistant with
Occipital
Neuralgia, such as
associated with headache that can
mimic migraine headache (brain tumors, lesions, etc.).
, which is often misdiagnosed. The bald truth is that localizing signs of brain tumor include a loss of vision on the side of an occipital neoplasm. Compare
occipital abscess, a
pyogenic brain abscess, usually of bacterial origin. Thrombus
is hyperdense on CT : compare hyperdense
temporo-occipital hematoma.
NONTRAUMATIC NEUROEMERGENCIES
Types
of Wrong Diagnosis - CureResearch.com Related
Condition Misdiagnosis - CureResearch.com
Systemic infection is a common complication of
stroke. However, brain abscess as a complication of stroke has
never been reported.
www-medlib.med.utah.edu/kw/sol/sss/ subj2.html - 65k - Cached
(Further, tumors of the occipital lobe specifically may produce homonymous hemianopia or partial visual field deficits.) According to my research it can also suggest 1) a neurotoxic amyloid-like protein deposit or plaque which is the hallmark of Alzheimer's disease, including recent onset Alzheimer's), 2 ) an "old occipital bleed" such as from an old injury, 3) or a occipital dermoid cyst, or abscess secondary to occipital dermoid cyst which is the hallmark of a brain abscess, or perhaps even a Subdural hematoma. A subdural hematoma is a collection of mostly "clotted blood" that accumulates between the brain and the skull.
Further findings suggest that abscesses can mimic OTHER CONDITIONS, including tumors in presentation and radiologic studies. Lung is the primary site of infection, but the brain is the second most commonly involved organ and may be caused by staph if there are hemorrhagic multiple abscesses. A bacterial brain abscess may mimic brain tumors, and may cause death due to herniation. Next: Misdiagnosis of Underlying Causes of Death
Pseudotumor Cerebri can easily be confused with a brain tumor because its symptoms closely mimic those of brain tumors, possibly because of abnormal buildup of cerebrospinal fluid placing pressure on the brain. Pseudotumor cerebri is diagnosed by ruling out all other possible causes for symptoms and confirming that the cerebrospinal fluid pressure is increased. Tumor Types: Other Brain Related Conditions
See:
Pseudotumor Cerebri, literally means "false
brain tumor". It is caused by increased pressure within the brain
and is most common in women between the ages of 20 and 50.
Compare:
Demyelinating Pseudotumor - because it can
mimic a variety of other diseases (such as brain tumors,
meningitis, systemic lupus erythematosis, etc.), PTC is generally a
diagnosis of exclusion.
Pseudotumor Cerebri: Differential Diagnosis
Further findings suggest the
CT scan appearance of cerebritis is that of an ill-defined hypodense
contrast enhancing area, or a CT scan that shows decreased density
and loss of definition = NOT WELL OPACIFIED -->Blood Clots (hematomas),
microabscesses or bacterial infection of the CNS. Symptoms are those of a flu-like illness, with evidence of brain involvement indicated by lethargy, confusion, irritability, tremors, or seizures. Compare Mimics
of Brain Tumor on Neuroimaging: Part II. These include subdural
hematomas, brain abscesses, hydrocephalus, benign intracranial
hypertension, etc...
hepatic abscess appears as a single or multiloculated mass with
low attenuation, suggestive of "decreased attenuation".
Brain abscess is caused by intracranial
inflammation with subsequent abscess formation, and may occur
within the
cerebral hemispheres.
Compare:CT
Scanning..
Clinical presentation of brain abscess is usually similar to other
intracranial space-occupying lesions. Systemic symptoms are usually mild and fever may not be obvious. However, the
symptoms
of an abscess tend to be more rapidly progressing than those associated
with a neoplasm. Compare Neuroradiology
Imaging Teaching Files showing a Cerebral Abscess
with midline shift.
Further, spontaneous haemorrhage associated with a brain abscess including
spontanuous
brain absesses as a complication of stroke is reported in the
literature.
Further submit that the occipital lobes interpret vision. Had it been
a recent tumor, there would have been onset visual misperception with
visual impairment and subsequent loss of vision with evolution. Arlene
Berry had NO visual deficits, indeed she had "No focal deficits", apart
from the signs and symptoms of hepatic dysfunction which the ED physician
failed to in his duty of care to recognize. The patient had even been
oriented to date, place and time at the time of her admission to the
Kirkland and District Hospital on May 23rd of 2000.
Dr. Mclellan also provided us with a view of a CT scan which he
purports that was done at the time of Arlene's death . It reveals numerous
blood clots and traumatized tissue with brain abscesses (blood and pus
isolates), including visceral microabscesses and/or blood clots with
massive edema of the right cerebral hemisphere, including a 1 cm midline
shift that is consistent with
Bacterial
(pyogenic)
infections of the CNS: and herniation.
CAVEAT:
Purulent exudates, clotted blood, radiation necrosis, and fibrinous deposits are usually the result of trauma (including clinical insult), and infection, or both.
Disseminated abscesses can occur in multiple organs,including the
brain, eyes, kidney, heart, liver and spleen.
Staphylococcus aureus
abscesses often occur following haematogenous (blood borne)
infections.
Further findings suggest WBC elevated with abscesses. Compare
CNS Infection
hepatic abscesses. Brain abscess is caused by
Iintracranial inflammation with subsequent abscess formation.
See
Intracranial abscesses in adults: an analysis of 54
consecutive ... in which Staphylococcus aureus was the
most commonly found causative agent.
Central nervous system infections
Compare -MeSH
definition:MeSH Hierarchy
The radiographic appearance of brain metastases is
nonspecific and may mimic other processes, such as infection.
Therefore, the CT or MR scan must always be interpreted
within the context of the clinical picture of the individual
patient, particularly since cancer patients are vulnerable to
opportunistic CNS infections.
Primary and Metastatic Brain Tumors
Further submit that a Computed
Tomography, or CT scan measures density (images represent
density) and cannot by itself
differentiate between blood clots and tumors. All cerebral hematomas,
whatever the cause, have a similar resolution pattern on CT. Plain
radiographic findings are nonspecific, but they may be useful in showing
the extent of associated skeletal trauma. Vascular malformations and brain
tumors are better visualized on MRI. Magnetic resonance imaging (MRI) of
the head is done to: 1)Evaluate blood flow to the brain, 2)MRI can
diagnose bleeding in or around the brain, 3)Diagnose tumors, infections,
or inflammatory conditions (such as encephalitis or meningitis) of the
brain or brain stem; hence with
MRI, it is easier to detect tumors, chemical reactions,
blood clots, and so on. MRI scan of the brain
is becoming the imaging modality of choice for brain tumors
Diagnosis of primary brain tumors in the elderly is more difficult and often delayed due to nonspecific symptoms that mimic the physical and cognitive changes seen in the normal aging process Monofocal acute inflammatory Demyelination (MAID): lesions present as large masses that mimic brain tumors. Headaches and motor deficits were the most common presenting symptoms. Language problems and motor deficits were the most common findings on physical examination
ALTERED LEVEL OF CONSCIOUSNESS AND COMA
Drug intoxication is a reversible cause of coma that might
mimic brain death.
It is important to distinguish between brain death, states that mimic brain death such as drugs that acts as central nervous system (CNS) by virtue of this produce a wide spectrum of effects, from mild sedation to anesthesia. Misdiagnosis of brain death is possible if a locked-in syndrome, hypothermia, or drug intoxication is not recognized. Locked In Syndrome is characterized by complete paralysis except for voluntary eye movements. It is usually caused by lesions in the nerve centers that control muscle contractions, or a blood clot that blocks circulation of oxygen to the brain stem.
Prochlorperazine is contraindicated
in the presence of coma or severe CNS depression, bone marrow depression,
blood dyscrasia, circulatory collapse, subcortical brain damage,
Parkinson's disease, liver damage, cerebral arteriosclerosis, coronary
disease, severe hypotension or hypertension. Prochlorperazine
- The Doctors Lounge(TM)
Drug screens may be helpful but may miss certain drug
types. Alcohol, barbiturates, antiepileptics, benzodiazepines,
antihistamines, antidepressants, antipsychotics, stimulants
such as amphetamines, narcotics,
analgesics,
and many of the cardiovascular drugs can all be traced in most
toxicological screens. In addition, several drugs induce acid-base
abnormalities that should already point to a possible intoxication. Multisystem organ failure and death have resulted from severe overdose with Antihistamine Toxicity.
Respiratory acidosis is associated with opiates, ethanol,
barbiturates, and anesthetics.
Metabolic acidosis is common in acetaminophen,
ethanol and methanol, as well as ethylene glycol, salicylates, isoniazid,
cyanide, cocaine, strychnine and papaverine.
BRAIN DEATH -
Electroencephalogram (EEG) which measures the electrical
activity of the brain may mimic brain death
EEG Alone Cannot Diagnose Brain Death -- Neurotransmitter.net
Anesthetic agents can closely mimic brain death
NEJM -- The Diagnosis of Brain Death
Drugs such as opioids, barbiturates, benzodiazepines,
phenothiazines, tricyclic
antidepressants ... derangement and endocrine crisis can mimic
brain death Clinical Exam
|
Drug intoxication is a reversible cause of coma that might mimic brain DEATH. |
||
In this case, an MRI to detect blood
clots or abscesses was NOT done.
HEMATOMA
- Definition
What
causes a brain abscess to form?
Abscesses arising from the extension of a paranasal sinus infection often
contain the bacterium Streptococcus , and abscesses resulting from
trauma contain bacteria of the "Staphylococcus" variety.
The
only test that can absolutely make a diagnosis of a brain tumor is a
biopsy. NO Magnetic Resonance (MRI) Testing was done. NO
brain
biopsy was done. See:
CT-guided biopsy
Further, NO autopsy was done to acurately deternine cause of death .
Among causes of Hemorrhagic Stroke include untreated hypertension,
coagulopathies, and ICP (Increased Intracranial Pressure).
With the decreased attenuation throughout the cerebral hemispheres
due to rapid or spontaneous development of blood clots there would have
been little or no perfusion.
Had Arlene Berry been started on corticosteroids (cortocosteroids: a
type of steroid usually given to reduce inflammation) to reduce brain
swelling, and had she been treated responsibly with appropriate antibiotics, she could have enjoyed
respite from her condition and may have recovered without further
complications. But without timely response due to medical mismanagement
and criminal negligence on the part of the doctors and nurses involved
herein, Arlene Berry died unnecessarily.
Further findings suggest that patients with a diagnosis of a primary
or metastatic
brain
tumor associated with a CNS event should have a meticulous
review of their history for possible "iatrogenic" causes. As can be seen
from this case, little or no attention was paid to the patient.
Further submit that drug intoxication is a reversible cause of coma that
might mimic brain . Further, coma with fixed, dilated pupils and an
isoelectric electroencephalogram can mimic brain . Acute metabolic
derangement and endocrine crisis can mimic brain but more often diffuse
cerebral edema, extensive demyelination, or anoxic ischemic injury, is a
consequence of these derangements. Examples are brain edema in fulminant
hepatic failure. In this case there was evidence of massive cerebral edema.
Compare Ischemic stroke: in which basilar artery thrombosis impairs brainstem perfusion and can cause coma at onset. Large hemisphere ischemic strokes may develop massive cerebral edema and result in compression of the brainstem over days from onset. Cerebellar hemisphere strokes (ischemic or hemorrhagic) can result in coma over hours to days. With demyelination, mass lesions can mimic brain tumors. Monofocal acute inflammatory demyelinating (MAID) lesions present as large masses that mimic brain tumors. The natural history and nosologic classification are not well defined.
"In a 1995 report on arthritis
and fungus, Orian Truss, M.D., state the very same thing when he educates
the reader to the fact that systemic yeast conditions even
mimic brain tumors! How could doctors have overlooked this
incredible pathogen? Misdiagnosed patients are often relegated to months
of antibiotic therapy which does one thing very well - it perpetuates
fungus!" A bacterial brain abscess
may mimic brain tumors, and may cause death due to
herniation Most abscesses must be surgically drained, because
antibiotics do not penetrate them very well.
See
Bacterial Pathogenesis.
The College of Physicians and Surgeons of Ontario conducted an
investigation into the death of Arlene Berry which consisted primarily of
downplaying all complaints by "omission" and in fact failing to address
the key concerns put forth. They deliberately ignored evidence of altered
medical records. The bald truth is that they "tailored" the investigation
"to suit themselves". The investigator, C. Michelle Mann was either
uninformed, ignorant, or outright criminal in her investigation.
To downplay by omission is to "obfuscate the truth". In my opinion she
violated the provisions of the Criminal Code. All of the doctors and
hospitals named in the Arlene Berry coverup were "partners" in the NORTH Network, a telehealth experiment undertaken by the Harris
government from a 1995 OMA study to compensate for hospital funding
cutbacks and doctor shortages. They all had and still have a vested
interest in protecting each other against the legal s of treating patients
unseen at arm's length, over the telephone . They are now, by their own
doings the key players in the Arlene Berry coverup conspiracy for which I
will hold all of them criminally liable.
Dr. Barry McLellan was one of the original proponents of the NORTH
project, leaving his position as medical director of the North network to
become Regional Coroner for Northeastern Ontario. In fact, he was
affiliated and closely tied to all of the doctors and hospitals named in
the Arlene Berry "coverup", all of whom were partners in the North
telehealth network. As such, Dr. McLellan had a personal and vested
interest in the Arlene Berry case as to affect his personal judgment. He
allowed his professional duty to come into conflict with his personal
interests as to constitute a conflict of interest, ahead of public duty,
which he misused for personal ends. Conflict of interest is a precondition
for biased or corrupt behaviour. He had a duty to disclose such interest(s)
and by failing to do so he acted illegally, and in my opinion, contrary to
the provisions of the Criminal Code of Canada, via provisions related to
corruption in public office, and the Conflict
of Interest Code, breach of
trust and public endangerment.
Case in Point:
SERIOUS breach of standard which goes to impeach the credibility of the
Coroner's investigation into the unnecessary death of Arlene Berry.
Further, Dr McLellan was Vice-President of Medical Trauma and Clinical
Services at Sunnybrook Health Science Centre in Toronto Ontario for 5
years. He was medical director of the NORTH Network and had recently
assumed the position of Regional Coroner. A question has arisen with
respect to his "relationship" to Dr. Mark Spiller?
180. A family request for a formal inquest into Arlene Berry's death elicited to
following response from Dr.McLellan: "I want to stress that an inquest is
not intended to be the vehicle by which someone is found to be responsible
or accountable ...". As a result of my investigation and having
carefully reviewed all information available I do not feel.. that a jury
might make useful recommendations directed to the avoidance of similar
circumstances". . "The venue to determine accountablity is either the
criminal or civil courts". . "After careful consideration of all
information available to me I have therefore made a decision to not hold
an inquest into Ms. Berry;s death ".
181. Further, Dr. McLellan had told the deceased's family that he had no
dealings through his office with the College of Physicians & Surgeons. He
"lied", in fact he conducted what Dr. Jordan's legal counsel described as
a "parallel investigation" with "multiple communication" between the
Coroners' office and the College. The Coroner had seized the medical
records for almost a year before family was allowed to get them. The KDH
would not release them to us without Dr. McLellan's approval even after
Dr. McLellan had completed his investigation. The Coroner possesses
superior knowledge or the means of discovering discrepencies in the
medical record which he either ignored or deliberately withheld from the
police - turning a blind eye that which should have been obvious or
suspicious.
Medical omission, especially lack of diagnostic thoroughness, medication
errors, negligent and callous nursing care, and even ignoring symptoms and
outcomes to FATAL conclusions undoubtedly permeate hospital case histories
at the Kirkland and District Hospital. Tales of such negligence, bedeviled
by imprudent nurses, with variances of the play dumb rule invariably
fill the Kirkland and District Hospital patient records with disgust to
excess.
At the time of her death, I was informed that Arlene Berry's eyes had been
taken by Dr. Sauv?#060;b> at the Sudbury Regional Hospital upon remote party
consent, utilizing deception to obtain that consent, bypassing permission
from Arlene Berry's immediate family. According to Dr. Jordan she was
transferred to Sunbury under the care of Dr. Adegbite. She ultimately
ended up under the care of Dr. Sauv?#060;b> No pathological confirmation of the
cause of death was given on the death certificate. According to Dr. Sauv?#060;/b>
she died meeting brain death criteria. Iterestingly, Dr. Sauv?#060;/b>
was a classmate
of Dr. Spiller from the U of T class of '89.
The fraudulent taking of the patient's eyes to conceal the true nature of
the death is seen as theft? The investigation continues, however, new
evidence suggests that the Dr.Sauv?#060;/b>merely pretended to take the deceased
victim's eyes to conceal sunken eyes associated with "dehydration" associated with a withdrawal of
life support in a critically ill patient, or occular lessions associated with toxic epidermal necrolysis
(TEN), or a variant thereof in which the eyes may become very painful, swell, and become so filled with pus that they seal shut, which more precisely fits the description of what happened in this case. Drug eruptions can mimic almost any inflammatory dermatosis. Epidermal loss predisposes patients to infection and sepsis. See: Toxic shock syndrome or toxic epidermal necrolysis? Case reports showing clinical similarity and histologic separation. Compare Compare Clinical Manifestations associated with Dangerous Drug Eruptions in TEN. The differential diagnosis to be considered is the toxic shock syndrome caused by Staphylococcus aureus ...
Compare sunken eyes in Nonketotic
Coma. Nonketotic coma is associated with a severe
infection or kidney failure.. See:
Acute kidney failure.
Compare Acute oculogyric crisis after administration of prochlorperazine. Oculogyric Crisis (rolling eyes)usually occurs as a
side effect
of neuroleptic drug treatment.
From the record, the ED physician, Dr. Spiller is guilty of negligence in
failing to use reasonable care under the circumstances to discover a
foreseeable dangerous condition, i.e. with respect to a "resistant
bacteria", a condition which Dr. Spiller and the healthcare providers who
attended to the patient, which each of them either knew or should have
known due to being in a position of superior knowledge, and in failing to
warn each other as well as the attending physician of its existence,
and/or to exercise appropriate monitoring, dilligence or caution, and in
failing to diagnose and treat toxic shock syndrome associated with a
resistant bacteria resulting in substantial bodily harm and subsequent
death . In my
opinion Dr. Spiller is guilty of of criminal negligence causing bodily
harm, or a party to manslaughter by gross negligence.
Toxic Shock Syndrome: A Health Professional's Guide
The Stated Case - Findings: Under Construction 1,
2, 3,
4, 5,
6, 7..
ADDITIONAL FINDINGS:
Case: 10-day
history of headaches.
The genetic simplicity of many infectious agents allows them to undergo
rapid evolution and to develop selective advantages that result in
constant variation in the clinical manifestations of infection. Case
- brain abscess
Very
few headaches (less than 5 percent) are caused by tumors
Other indications of toxicity include hair loss, kidney
damage, bone and liver damage and headaches. It could also cause
you to mimic brain tumors on an x-ray, and your vision could be
blurred.
FSHN Mod 18
Clinically, many conditions producing increased intracranial pressure or progressive neurologic deficits mimic brain tumors. Ref: [PDF] Clinical, imaging, and laboratory diagnosis of brain tumors ...
Bacterial meningitis and brain abscesses are
relatively common intracranial infections.
Suspected reasons for the cover-up: 1) Outbreaks
of nosocomial invasive infections may become the subject of adverse
publicity and legal
suits against institutions and medical personnel. 2) The adverse publicity
associated with gram-negative meningitis
type hospital acquired
infections may deter patients from seeking care at the facility and may
influence potential financial contributors to support other facilities. 3)
Doctors and nurses could face criminal charges of all kinds in this case,
ranging from patient neglect to under-treatment to criminal negligence
causing death; accessory related (altering medical records), and criminal
conspiracy - including medical
shame, etc. 4) Legal consequences could
give rise to possible domino-effect whereby if Dr. Jordan goes down - may
cause all others involved to fall down in succession. This is by far the
most sordid instance of lack of due diligence on the part of all connected
parties.
Arlene Berry did NOT live long enough to meet her May 30th appointment
appointment1.3
appointment2.3
appointment3.3
Reference:
MAIN SEARCH INDEX.
ISOLATION AND IDENTIFICATION OF STAPHYLOCOCCI
Pathogenesis of Staphylococcal Infections

Virtual Slide - Seminar-Tutorial Slide Review
Toxicity - state of being poisoned. Also, adverse effects created by a ...
This Site Is Dedicated To Malpractice Prevention
Redress Information & Analysis
www.meverett.com

"Nobody made a greater mistake
than he who did
nothing because he
could do only
a little." (Edmund Burke,
political thinker
* * * * *
Truth/Justice/
Patient Safety * *
* * *
It's a
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Sowing The Seed For A Safer Medical Future
In Memory of Arlene Berry

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Kernig sign: A clinical hallmark of meningitis , inflammation of the meninges, the membranes covering the brain and spinal cord.
Toxin injures the endothelial cells, breaks down the blood-brain barrier, and provokes the neutrophil inflammatory response that is the hallmark of bacterial meningitis
The Internet Atlas of Patholgy.
UPMC Case Database Search Engine
Clinical Imaging/Mimic Brain Tumors
In 1979, Goldi observed that Mollaret¡¯s meningitis could occur without fever, have symptom-free periods from days to years, have increased CSF gamma globulin, and have transient neurologic signs and symptoms.
Meningitis due to Staphylococcus aureus.
Low-grade fever, malaise, poor feeding, and irritability in patients with CSF shunts should raise suspicion of meningitis, even when high fever, stiff neck, severe headache, and nausea/vomiting are absent. Patients may develop a brain infection or staph infections at other body sites. Excessive bleeding and shock can develop.
Meningococcal disease is any infection caused by the germ 'meningococcus', which can cause meningitis (an infection of the membranes covering the brain and spinal cord), and septicaemia (a blood infection).
Reversible bundle branch block in phenothiazine toxicity. (A case report).
Proximal muscle weakness of the arms and legs is the hallmark of drug-induced myopathy.
An interruption of blood flow in the cerebral arteries, is the hallmarks of a stroke.
The hallmark of a stroke is the sudden onset of one-sided neurologic dysfunction, slurring of speech or unexplained dizziness.
hallmark of subarachnoid hemorrhage is a severe headache,
neuronal cell death that is the hallmark of stroke
UCSD researchers decipher function of blood-brain barrier in bacterial meningitis
Pathogenesis of bacterial meningitis depends on a defect in the blood-brain barrier, bacterial virulence factors, and host defense factors. The hallmark of meningitis is inflammation of the meninges, causing an increase in intrathecal pressure. Bacteria in the subarachnoid space can cause release of active cytokines that increase vascular permeability and result in a corresponding rise in intracranial pressure. The increased pressure causes cerebral ischemia, altered mental status, and cellular damage that can give rise to long-term complications. Patients with viral or aseptic meningitis tend to have a milder course, but will still develop some degree of elevated CNS pressure leading to long-term sequelae.
abscesses - local infections lead to the formation of a collection of pus (neutrophils) called an abscess.
The many faces of Staphylococcus aureus infection in meningitis. The infection presents in two distinct settings. Hematogenous S aureus meningitis occurs in association with overwhelming, disseminated infection. S aureus may also be involved in meningitis occurring after neurosurgical procedures. In such circumstances, it is usually associated with the presence of a foreign body. In a Danish study by Jensen and associates (12), hematogenous S aureus meningitis had a mortality rate of 56%, compared with 18% in postoperative infection.
As the body tries to fight the infection, blood vessels become leaky and allow fluid, white blood cells, and other infection-fighting particles to enter the meninges and brain. This causes brain swelling and eventually can result in decreasing blood flow to parts of the brain, worsening the symptoms of infection
eMedicine - Meningitis, Bacterial : Article by Lutfi Incesu, MD
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multiple blood clots in the CSF are the initial cause of post-hemorrhagic ventricular dilatation and lysis of clots
http://www.hoslink.com/LabResults/Neurologic.htm
http://www.csuchico.edu/biol/personnel/Hanne/GenBactNotes/Lect36UTI.html
In aseptic meningitis, mononuclear forms, especially lymphocytes,
predominate
CNS infections
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http://www.prn.usm.my/cect/cect16.html
http://iweb.lati.tec.sd.us/STAFF/GLEYSTEM/webpage/ChemistrySheets/Tumor%20Markers.htm
http://ca.geocities.com/dynamic_resources2004/FILE1.HTM