Examination 3 - direct of attending nurse in med mal suit
LAURIE L. CARROLL, R.N.
Amicus Court Reporters, Inc.
and Mr. Goedert were the two nurses involved, 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.
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?
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?
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?
Q Because for some reason -- physiological reason it's easier for them to breathe in an upright posture?
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?
Q Are you familiar with the term that's heen thrown around this case, pulsus paradoxus?
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?
Q To see if there is a difference?
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?
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?
Q Did Dr. Waicosky testify at her deposition that peak flow data is something that she didn't require?
Q The peak flow data would not, in her opinion, alter any of the care that she was rendering?
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?
MR. BAKER: That's all I hare
MR. BURKE: Quickly. A very small point.
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?
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 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?
Q You said that -- Mr. Baker talked about the initial vitals that Dan took at 00:05 as being baseline information, 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 --
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'