Deviation in the Standard of Surgical Care Resulting in Nerve Damage (Neuropathy, Nerve Laceration)

Evaluate breaches in the standard of care by using your particular fact pattern to answer the questions herein below to determine whether or not there was a Deviation in the Standard of Surgical Care Resulting in Nerve Damage (Neuropathy, Nerve Laceration)

Answer the following questions to find out if the standard of care was followed for your case.

  • Which of the following risk factors were elicited from the patient?
    History of focal nerve abnormality in the area to be operated
    History of diabetes
    Obesity
    Alcoholism
    None elicited
    Answer unknown
    Why is this important?
    A complete and thorough medical history must be elicited from the patient prior to surgery.
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  • Was an informed consent obtained prior to the surgery? Why is this important?
    Answer this question
    
For any invasive surgery, the clinician must outline the entire procedure, all the complications associated with the procedure, all the risks of having the procedure and all risks of not having the procedure.

    (2002) 20 ENLOGC 2 305-338 



  • Which of the following nerve injuries did the patient develop? Why is this important?
    Answer this question
    
There are four underlying basic pathologic forces responsible for a neuropathy; stretch, compression, generalized ischemia and metabolic. Ultimately, all of these forces cause sufficient ischemia within a nerve to result in transient or permanent nerve structural or functional damage.

    (1996) 14 EANESC 3 561-572 



  • Which of the following precautionary measures were taken? Why is this important?
    Answer this question
    
Precautionary measures need to be taken to minimize the likelihood of nerve injury. 

    (1996) 14 EANESC 3 561-572 



  • Which of the following precautionary measures were taken? Why is this important?
    Answer this question
    
Proper positioning, the use of surgical materials, and the precise surgical technique will reduce the likelihood of certain types of nerve damage.

    (1996) 14 EANESC 3 561-572 



  • Were the upper extremity nerves injured during the surgical procedure? Why is this important?
    Answer this question
    
Any nerve that passes into the upper extremity may sustain an injury during the peri-operative period.

    (1996) 14 EANESC 3 561-572 



  • Was a lower extremity nerve injured during the surgical procedure? Why is this important?
    Answer this question
    
A number of studies have suggested that there are many factors other than improper intra-operative care that may contribute to the risk of lower extremity nerve injury.

    (1996) 14 EANESC 3 561-572 



  • Was the nerve injury addressed at the time of surgery? Why is this important?
    Answer this question
    
Most micro-surgically treated iatrogenic nerve injuries occur directly during an operation. Certain nerves are at a higher risk than others, and certain procedures and regions of the body are more prone to sustaining nerve injury.

    (2009) 20 ENSCNA 1 73-90 



  • Was the nerve injury managed at the time of surgery? Why is this important?
    Answer this question
    
Once a nerve injury has occurred intra-operatively, it is the duty of the clinician to manage the injury without delay to minimize damages.

    (2005) 63 ESURNU 1 5-18 



  • Was the patient referred to a specialist? Why is this important?
    Answer this question
    
Immediate referral of the patient to a neuron/micro-vascular/plastic surgeon must occur for the efficient management of the nerve damage.

    (2005) 63 ESURNU 1 5-18 



  • Which of the following signs and symptoms of motor injury did the patient exhibit immediately after surgery? Why is this important?
    Answer this question
    
Post-operatively, patients may experience symptoms like severe burning pain, numbness, tingling sensation, and loss of function of a body part due to nerve damage.

    (2009) 20 ENSCNA 1 73-90 



  • Was a physical examination performed on the patient ? Why is this important?
    Answer this question
    
The clinician must perform an immediate physical examination if the patient is exhibiting signs and symptoms of nerve damage, so that the nerve damage is immediately identified and its management is initiated.

    (1998) 16 ENLOGC 1 55-82 



  • Were investigative diagnostic studies performed? Why is this important?
    Answer this question
    
If the patient exhibits signs and symptoms of nerve damage, immediate investigations must be conducted by the clinician to identify the presence and extent of the damage.

    (2009) 20 ENSCNA 1 73-90 



  • Was the presence of nerve injury discovered immediately after surgery? Why is this important?
    Answer this question
    
Immediate detection and intervention by the clinician to reverse the nerve damage is mandatory.

    (2009) 20 ENSCNA 1 73-90