A*******s
发帖数: 9638 | 1 我在以前工作的一个州，认识很多朋友。 有个外科心血管医生， 与我关系不错。不过
已经5年没音讯了。
今天看了个病人， 来自我以前的那个州。 他非常抑郁， 因为他在去年一次主动脉瘤
手术中， 脊髓损伤，不能行走了。 他老婆带了个大包， 放满了文件。 他们说， 要
起诉他的手术医生， 因为他的残废， 让他们的日子无依无靠， 几个星期后， 他们的
房子要被拍卖。
手术医生就是我朋友。我简单的问了一下， 其实这类手术出现的并发症全美国只有4例
，医生并没有什么错误， 他们只是纠结术后的细节，问我的想法。
我只能说我是外行， 加说了一句， “我很同情你们的遭遇。” 我真说不出其他话来
。 当然， 他们不知道我认识手术医生。
不过即使我不认识手术医生， 我还是说同样的话。
|
S******9
发帖数: 2837 | 2 这种情况，你不能帮那个医生说些免责的话？
还是只能这样说？ |
A*******s
发帖数: 9638 | 3 我怎么说都是错的，所以什么也别说。
按你那么说， 病人更upset， 对你也不满。 你不说， 就是对同行的保护。
【在 S******9 的大作中提到】
: 这种情况，你不能帮那个医生说些免责的话？
: 还是只能这样说？
|
S******9
发帖数: 2837 | 4 哦，明白了
我考step1的时候有一道题目是一个病人要起诉一个医生，这个医生如何回答，我就是
好奇到底啥是正
确的
【在 A*******s 的大作中提到】
: 我怎么说都是错的，所以什么也别说。
: 按你那么说， 病人更upset， 对你也不满。 你不说， 就是对同行的保护。
|
A*******s
发帖数: 9638 | 5 不想误导step 1. 对这件事，我是这么处理。 具体问题可能还要具体分析。
【在 S******9 的大作中提到】
: 哦，明白了
: 我考step1的时候有一道题目是一个病人要起诉一个医生，这个医生如何回答，我就是
: 好奇到底啥是正
: 确的
|
S******9
发帖数: 2837 | 6 没关系，我已经考完了，估计选对了，行为是high performance
【在 A*******s 的大作中提到】
: 不想误导step 1. 对这件事，我是这么处理。 具体问题可能还要具体分析。
|
J****C
发帖数: 1465 | 7 Paraplegia is not an uncommon complication of TAA(or AAA) surgery. It's
hard to believe what you said "其实这类手术出现的并发症全美国只有4例". I
personally have seen 2 cases so far. Fortunately one case had relief
after emergent spinal drainage placement. The etiology is spinal
anterior column ischemia from underperfusion of the artery of Adamkewicz
which is a branch of the aorta and an important supplier of anterior
spinal artery, however with quite variable origin point. This is
described in every textbook and its risk has to be discussed with the
patient before surgery. An usual strategy for thoracic AA or suprarenal
AA surgery is to place a spinal drain to decrease CSF pressure (to about
9-10mmHg) during surgery to ensure sufficient perfusion.
Of course it is a catastrophic complication, however the other result of
not having surgery is also catastrophic----AAA would rapture eventually
with a mortality rate up to 70%. Unless there's astray from standard
practice and there's negligence on the part of the surgeon (the two
essential constituents of malpractice), I think your patient has a
rather slight chance to win the suit.
【 在 Aplusplus (Hakuna Matata) 的大作中提到: 】 |
A*******s
发帖数: 9638 | 8 Well said. Thanks for the comments.
I meant the surgery type for AAA which my friend did only had 4 cases
reported as complications, not sure if all were spinal injuries. I didn't want to disclose the name of
surgery for his privacy. But all info including the name of surgery was
from my patient.
He is not going to win as far as I know.
【在 J****C 的大作中提到】
: Paraplegia is not an uncommon complication of TAA(or AAA) surgery. It's
: hard to believe what you said "其实这类手术出现的并发症全美国只有4例". I
: personally have seen 2 cases so far. Fortunately one case had relief
: after emergent spinal drainage placement. The etiology is spinal
: anterior column ischemia from underperfusion of the artery of Adamkewicz
: which is a branch of the aorta and an important supplier of anterior
: spinal artery, however with quite variable origin point. This is
: described in every textbook and its risk has to be discussed with the
: patient before surgery. An usual strategy for thoracic AA or suprarenal
: AA surgery is to place a spinal drain to decrease CSF pressure (to about
|
N*******r
发帖数: 118 | 9 It's a common practice, as I know, to insert a lumbar drain before aortic
cross-clamping for spinal cord protection during any open TAA/high level AAA
repair.
The spinal cord injury secondary to the anterior columns ischemia caused by
aortic cross-clamping is a known risk for open AAA/TAA repair, but it's a
relatively rare event with the incidence of 0.1%.
want to disclose the name of
【在 A*******s 的大作中提到】
: Well said. Thanks for the comments.
: I meant the surgery type for AAA which my friend did only had 4 cases
: reported as complications, not sure if all were spinal injuries. I didn't want to disclose the name of
: surgery for his privacy. But all info including the name of surgery was
: from my patient.
: He is not going to win as far as I know.
|
A*******s
发帖数: 9638 | 10 According to the patient, the surgery my friend did is a new method which
only limited cases were done nationwide.
AAA
by
【在 N*******r 的大作中提到】
: It's a common practice, as I know, to insert a lumbar drain before aortic
: cross-clamping for spinal cord protection during any open TAA/high level AAA
: repair.
: The spinal cord injury secondary to the anterior columns ischemia caused by
: aortic cross-clamping is a known risk for open AAA/TAA repair, but it's a
: relatively rare event with the incidence of 0.1%.
:
: want to disclose the name of
|
|
|
f******w
发帖数: 10267 | 11 每一个手术都有风险，病人心理上不能接受后果也是可以理解的。上次你转的那个
58million的case，真的很想知道当时那个医生是怎么想的，羊水只剩一半还不赶紧刨
了，等啥呢？
【在 A*******s 的大作中提到】
: According to the patient, the surgery my friend did is a new method which
: only limited cases were done nationwide.
:
: AAA
: by
|
A*******s
发帖数: 9638 | 12 No comments. :}
【在 f******w 的大作中提到】
: 每一个手术都有风险，病人心理上不能接受后果也是可以理解的。上次你转的那个
: 58million的case，真的很想知道当时那个医生是怎么想的，羊水只剩一半还不赶紧刨
: 了，等啥呢？
|
A*******s
发帖数: 9638 | 13 我在以前工作的一个州，认识很多朋友。 有个外科心血管医生， 与我关系不错。不过
已经5年没音讯了。
今天看了个病人， 来自我以前的那个州。 他非常抑郁， 因为他在去年一次主动脉瘤
手术中， 脊髓损伤，不能行走了。 他老婆带了个大包， 放满了文件。 他们说， 要
起诉他的手术医生， 因为他的残废， 让他们的日子无依无靠， 几个星期后， 他们的
房子要被拍卖。
手术医生就是我朋友。我简单的问了一下， 其实这类手术出现的并发症全美国只有4例
，医生并没有什么错误， 他们只是纠结术后的细节，问我的想法。
我只能说我是外行， 加说了一句， “我很同情你们的遭遇。” 我真说不出其他话来
。 当然， 他们不知道我认识手术医生。
不过即使我不认识手术医生， 我还是说同样的话。
|
S******9
发帖数: 2837 | 14 这种情况，你不能帮那个医生说些免责的话？
还是只能这样说？ |
A*******s
发帖数: 9638 | 15 我怎么说都是错的，所以什么也别说。
按你那么说， 病人更upset， 对你也不满。 你不说， 就是对同行的保护。
【在 S******9 的大作中提到】
: 这种情况，你不能帮那个医生说些免责的话？
: 还是只能这样说？
|
S******9
发帖数: 2837 | 16 哦，明白了
我考step1的时候有一道题目是一个病人要起诉一个医生，这个医生如何回答，我就是
好奇到底啥是正
确的
【在 A*******s 的大作中提到】
: 我怎么说都是错的，所以什么也别说。
: 按你那么说， 病人更upset， 对你也不满。 你不说， 就是对同行的保护。
|
A*******s
发帖数: 9638 | 17 不想误导step 1. 对这件事，我是这么处理。 具体问题可能还要具体分析。
【在 S******9 的大作中提到】
: 哦，明白了
: 我考step1的时候有一道题目是一个病人要起诉一个医生，这个医生如何回答，我就是
: 好奇到底啥是正
: 确的
|
S******9
发帖数: 2837 | 18 没关系，我已经考完了，估计选对了，行为是high performance
【在 A*******s 的大作中提到】
: 不想误导step 1. 对这件事，我是这么处理。 具体问题可能还要具体分析。
|
J****C
发帖数: 1465 | 19 Paraplegia is not an uncommon complication of TAA(or AAA) surgery. It's
hard to believe what you said "其实这类手术出现的并发症全美国只有4例". I
personally have seen 2 cases so far. Fortunately one case had relief
after emergent spinal drainage placement. The etiology is spinal
anterior column ischemia from underperfusion of the artery of Adamkewicz
which is a branch of the aorta and an important supplier of anterior
spinal artery, however with quite variable origin point. This is
described in every textbook and its risk has to be discussed with the
patient before surgery. An usual strategy for thoracic AA or suprarenal
AA surgery is to place a spinal drain to decrease CSF pressure (to about
9-10mmHg) during surgery to ensure sufficient perfusion.
Of course it is a catastrophic complication, however the other result of
not having surgery is also catastrophic----AAA would rapture eventually
with a mortality rate up to 70%. Unless there's astray from standard
practice and there's negligence on the part of the surgeon (the two
essential constituents of malpractice), I think your patient has a
rather slight chance to win the suit.
【 在 Aplusplus (Hakuna Matata) 的大作中提到: 】 |
A*******s
发帖数: 9638 | 20 Well said. Thanks for the comments.
I meant the surgery type for AAA which my friend did only had 4 cases
reported as complications, not sure if all were spinal injuries. I didn't want to disclose the name of
surgery for his privacy. But all info including the name of surgery was
from my patient.
He is not going to win as far as I know.
【在 J****C 的大作中提到】
: Paraplegia is not an uncommon complication of TAA(or AAA) surgery. It's
: hard to believe what you said "其实这类手术出现的并发症全美国只有4例". I
: personally have seen 2 cases so far. Fortunately one case had relief
: after emergent spinal drainage placement. The etiology is spinal
: anterior column ischemia from underperfusion of the artery of Adamkewicz
: which is a branch of the aorta and an important supplier of anterior
: spinal artery, however with quite variable origin point. This is
: described in every textbook and its risk has to be discussed with the
: patient before surgery. An usual strategy for thoracic AA or suprarenal
: AA surgery is to place a spinal drain to decrease CSF pressure (to about
|
|
|
N*******r
发帖数: 118 | 21 It's a common practice, as I know, to insert a lumbar drain before aortic
cross-clamping for spinal cord protection during any open TAA/high level AAA
repair.
The spinal cord injury secondary to the anterior columns ischemia caused by
aortic cross-clamping is a known risk for open AAA/TAA repair, but it's a
relatively rare event with the incidence of 0.1%.
want to disclose the name of
【在 A*******s 的大作中提到】
: Well said. Thanks for the comments.
: I meant the surgery type for AAA which my friend did only had 4 cases
: reported as complications, not sure if all were spinal injuries. I didn't want to disclose the name of
: surgery for his privacy. But all info including the name of surgery was
: from my patient.
: He is not going to win as far as I know.
|
A*******s
发帖数: 9638 | 22 According to the patient, the surgery my friend did is a new method which
only limited cases were done nationwide.
AAA
by
【在 N*******r 的大作中提到】
: It's a common practice, as I know, to insert a lumbar drain before aortic
: cross-clamping for spinal cord protection during any open TAA/high level AAA
: repair.
: The spinal cord injury secondary to the anterior columns ischemia caused by
: aortic cross-clamping is a known risk for open AAA/TAA repair, but it's a
: relatively rare event with the incidence of 0.1%.
:
: want to disclose the name of
|
f******w
发帖数: 10267 | 23 每一个手术都有风险，病人心理上不能接受后果也是可以理解的。上次你转的那个
58million的case，真的很想知道当时那个医生是怎么想的，羊水只剩一半还不赶紧刨
了，等啥呢？
【在 A*******s 的大作中提到】
: According to the patient, the surgery my friend did is a new method which
: only limited cases were done nationwide.
:
: AAA
: by
|
A*******s
发帖数: 9638 | 24 No comments. :}
【在 f******w 的大作中提到】
: 每一个手术都有风险，病人心理上不能接受后果也是可以理解的。上次你转的那个
: 58million的case，真的很想知道当时那个医生是怎么想的，羊水只剩一半还不赶紧刨
: 了，等啥呢？
|
