Examination 3 - direct of attending nurse in med mal suit

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Representing: Defendant

LAURIE L. CARROLL, R.N.

Amicus Court Reporters, Inc.

Phone:312-641.3500

Fax:312-641.3795

Email:info@amicusreporters.com

and Mr. Goedert were the two nurses involved, correct?

A Correct.

Q Do you know of any other nurse that assisted in any way in assessing this patient before the arrest, no matter how small?

A We don't know of any curse; but what I do know is, from working in an ER, that it doesn't fall just on one nurse. I mean, I could just be a nurse walking by, and it would be my responsibility to assess a patient if I thought they were having any difficulty.

Q Right.

Let me just step back.

When Mr. Goedert left the room, whatever lime that was, at 00:05 or some time before that, he's not back to see this patient or assess him before the arrest; is that true?

A I don't think so. I don't think he recalled having any other interaction until the patient arrested.

Q And then, other than Mr. Goedert and Mr. Ogrentz, you're not aware of any nurse who made any assessment of this patient?

A Not that I'm aware of.

Q And what you're saying is that, if a nurse walked by and if he or she did look in and did have the time to assess him, they might have?

A Yes.

Q But we don't know that?

A We don't know that.

Q Is it your understanding that at all times he was sitting up on the stretcher in the room?

A Yes

And 1 don't dunk that he would have done it any other way. I mean, my experience with patients with difficulty breathing, or with any kind of respiratory issue, is they won't let you lay them down.

Q Okay. It wasn't -- if I understood you, it wasn't surprising that you read and saw that he was sitting up all the time?

A Correct.

Q Because for some reason -- physiological reason it's easier for them to breathe in an upright posture?

A Yes.

And that really is the most common position for anyone, astlima, both pre, post, during.

Q 1 think earlier you told me -- and if I'm mistaken, you're allowed to correct me -- that at least on a couple of occasions you interrupted the nebulizer treatment of parteni in order to perform a PEFR measurement, a peak flow measurement?

A I don't think 1 said that.

Q Let me ask you then.

Have you ever interrupted a nebulizer treatment to administer a peak flow measurement?

A I don't recall that specifically.

Q Have you ever heard of anyone suffering a respiratory arrest because of an interruption of nebulizer treatment to do a peak flow measurement?

A No.

Q Are you familiar with the term that's heen thrown around this case, pulsus paradoxus?

A Yes.

Q As a nurse, is that a thing that a nurse could do in 2002?

A Yes, you can. It's a blood pressure measurement.

Q Is it a blood pressure measurement that's done during expiration or inspiration?

A Both.

Q To see if there is a difference?

A Yes.

Q And if there's a difference, that can be a sign of respiratory problems?

A It can, yes.

Q And the difference would he you would see a decrease during inspiration?

A You would see a decrease -- well, no. You would actually see so increase during expiration.

Q Because it's harder to get the air out?

A Correct.

Q In patients who are having an acute asthma attack and it's worsening, the respiratory rate will go down?

A It may.

Q Because of what?

[Note: Pages 98-121 missing in original document]

that reason, so everyone has the opportunity to see it.

Q Did Dr. Waicosky ever order anyone to perform a peak flow on Mr. Bell?

A No.

Q Did Dr. Waicosky testify at her deposition that peak flow data is something that she didn't require?

A Yes.

Q The peak flow data would not, in her opinion, alter any of the care that she was rendering?

A Correct.

Q And that it was more important to her that the nurses give the nebulizer treatments rather than interrupt the nebulizer treatments, even if was momentarily, to do a peak flow?

A And that's true.

Q And is there anything that she ordered for Mr. Bell mat the nurses didn't carry out?

A No.

MR. BAKER: That's all I hare

MR. BURKE: Quickly. A very small point.

FURTHER EXAMINATION

by Mr. Burke:

Q But Dan's note there at 00:05 on the vitals, could that heart rate -- I don't mean to argue about it, but could that be 120?

A This one?

MR. BAKER: We'll have to look at his dep to see what it was.

MR. BURKE; I'm just curious.

THE WITNESS: A It could. That could very well be a one, two, oh.

MR. BURKE: Q When it says peak flow here, what's that referring to?

A Where?

Q It says O2 sat. Then it says peak flow.

A That's where you can do??ent what your peak flow was.

Q In their standardized charts they have a column where you could ??ter the peak flow measurements?

A They do.

But obviously, it isn't a measurement that's done on every patent. So it would -- no, you don't monitor a peak flow on every parient.

Q No?

A No.

Q But you do on acute asthmatic patients?

A But that wasn't a chart for acute asthmatic patients.

Q But there is a space. If they wanted to enter it, they could have?

A With any kind of flow sheet you're trying to anticipate what some of the more common things would be so you could just fill them in.

Q And a peak flow measurement is one of the common measurements for an acute asthmatic patient?

A Yes.

Q You said that -- Mr. Baker talked about the initial vitals that Dan took at 00:05 as being baseline information, correct?

A Correct.

Q And as far as you know, it's important to have baseline information on a patient so that you can see changes Groin the baseline over --

A Correct.

Q -- Time? Okay.

A Correct. Sorry.

Q With regard 10 the other physician that was in the emergency department, do you know what his name is or her name is?

A I do not.

Q Can you rell me who -- when exactly this other physician looked in on Mr. Bell in any way, sbape or form?

A No. I have no idea.

Q Can you tell me any period of time where that doctor, the second doctor, was at the nurses' station where the moniror would have been accessible to him?

A I do not know the period of tunc. All I know is that the physicians sit tight near the charge nruses in most ERs. So it's usually accessible

Q I didn't say that. Do you know a point from 00:05 up until 00:30 that that doctor was at the nurses'

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