Medical staff inaction blamed for death of passenger

[christitunes]

http://abcnews.go.com/GMA/story?id=4908671&page=1

Saw this today on Good Morning America. Basically, a man died 4 days after seeking medical attention, initially for treatment of nausea.

First, let me say that my heart goes out to the loved ones who endured this tragedy. It is such a sad story.

During the story, when family members pieced together the 4 days leading up to the death of the passenger, it became pretty obvious to me that the man was having or had had a heart attack. That was indeed what he died from 4 days later. During the 4 days leading up to his death, medical staff continued to treat him for nausea. When he worsened, the RN on board came to the room and took no vital signs besides a temp.

Thoughts or feelings, anybody? Nursiepoo, what do you think? I'm an LPN who has mainly worked in long-term care, but even a "young" nurse such as myself knows that you always take vitals as a matter of course. There is also so much current literature about heart attacks not always presenting with the classic chest tightness, shortness of breath, left arm pain, etc; still, nausea and vomiting are relatively common with heart attacks.

I know that there are two sides to every story, but it sounds to me as if the medical staff on this ship were not thorough enough when assessing the situation. It makes me think of the complaints I've read where people complain of being "kicked off" cruise ships because the onboard medical staff feels they need a higher level of care. I'm sure this family would have appreciated being sent ashore if it meant this man could have received life-saving interventions, esp. emergency airlifting back to the US.

[Phil&Liz]

They could/should have taken him to the infirmary, taken vitals and done an EKG.

Problem is some ACS are "silent" on EKG.

Using telemedicine to send a 12 lead EKG and exam info to another MD for back up would be a smart move. If this person had the name and number of their PCP the doc could/should have called to discuss the situation.

Anyone over 30 should carry with them a complete written summary of their healthcare/meds/PCP. The doc on board should then use the info to assist in making a course of treatment decision.

Biggest error here was the failure to do a thorough examination including vitals.

Phil & Liz

[Paul Motter]

Just an FYI: I know they weren't on Princess, but Princess does have telemedicine functionality on their Grand-class and newer ships.

It does bring up the controversy about getting "kicked off" the ships for being sick. In retrospect, not such a bad thing.

[christitunes]

Originally Posted by Paul Motter

Just an FYI: I know they weren't on Princess, but Princess does have telemedicine functionality on their Grand-class and newer ships.

It does bring up the controversy about getting "kicked off" the ships for being sick. In retrospect, not such a bad thing.

That's useful to know, thanks!

They also seem to have pretty reasonable single supplements which is another good thing for me. Maybe I'll check them out next.

[mehawk]

Hmmm.

[christitunes]

Originally Posted by mehawk

Hmmm.

...yeah, yeah; I know, you are loyal to Carnival. Well, I'm going on the Elation and can't seem to find one negative report on her, so maybe she'll earn my loyalty as well.

[Rev22:17]

Paul,

Originally Posted by You

Just an FYI: I know they weren't on Princess, but Princess does have telemedicine functionality on their Grand-class and newer ships.

It does bring up the controversy about getting "kicked off" the ships for being sick. In retrospect, not such a bad thing.

Yes, and Princess also uses (or at least did use, as of my last cruise) British physicians and nurses who are properly trained and licensed under standards comparable to those in the United States. Also, Princess's physicians and nurses, who work full time in the cruise industry, are specialists in emergency and urgent care with emphasis on the types of medical problems that tend to arise on cruise ships. By contrast, some other lines either contract with physicians licensed in "third world" countries where standards of training, certification, and licensing might not be so rigorous. I really wish that the major cruise guides would identify the nationalities of each cruise line's medical staff as part of their write-ups so that we could use that information in selecting cruise lines!

Norm.

[Lisa]

christitunes - as an experiened LPN, I can tell you that you can assess to the best of your abilities, but if the patient does not truthfully answer questions, that throws off your assessment. Vital signs alone can also be misleading.

And I agree with another previous poster, that cardiac problems can be silent or masked as indigestion or some other problem. I had a patient who I sent out because of GI problems and very abnormal CMP and LFT lab results - we were truly thinking gall bladder as was her primary MD. Imagine my shock when I called the hospital and was told that she was being admitted for a massive MI.......she absolutely had no symptoms of an MI. When she was hooked up to the tele in the ER after an hour there, they saw the irregularities and asked her if she was having chest pain; and she said "no". Her vital signs were all within normal parameters, she had no chest pain, SOB, pallor, diaphoresis, no pain in other parts of her body........

To die as this pax did is very sad, but sometimes you can do everything right an still be wrong. Happenes everywhere in the world.

[richstacy]

Paul says,

"It does bring up the controversy about getting "kicked off" the ships for being sick. In retrospect, not such a bad thing."

I guess it depends on where you are being kicked off. Is it a place with adequate medical facilities, or some third world substandard facility? One form of negligence can never justify another.

For me, it does bring to mind the opposite conduct of the heroic efforts of the captain and crew of the Norwegian Dawn who instead of kicking someone off, rescued two ill sailors in rough seas in one day yesterday I submit that for the average passenger, that is a confidence builder, not a confidence destroyer.

[mehawk]

Originally Posted by christitunes

...yeah, yeah; I know, you are loyal to Carnival. Well, I'm going on the Elation and can't seem to find one negative report on her, so maybe she'll earn my loyalty as well.

I didn't respond in kind because of my loyalty to Carnival. I didn't know the passenger was on a Carnival ship. I was responding in such because of the trials of the passenger.