Concept - cardiac arrest at hospital emergency room

Case Reference:

Plaintiff claimed that the standard of care called for immediate cardiac consultation and transfer for cardiac catheterization at both 10:30 p.m. and 1:30 a.m. Plaintiff’s proof was that decedent remained in the emergency room for some fourteen hours without a workup for catheterization. The jury found in favor of plaintiff for $1.3 million. M.L. Battien, etc, et al v. Dawn Dew, M.D., et al, Montgomery Co. (MD) Circuit Court No. 435831-V. Jonathan E. Goldberg,Tara Clary, Jonathan Huddleston of Schochor, Federico & Staton, for plaintiff.


cardiac arrest, cardiac consultation, cardiologist, chest pain, EKG, emergency, infarction, nitroglycerine, morphine, heart attack, heart damage

Case Overview

A patient arrived in the emergency room at 9:00 pm with severe chest pain after weightlifting. The initial EKG showed evidence of infarction, additional tests showed tissue damage to the heart, and the pain persisted after the administration of morphine.

Despite the evidence, the patient did not receive a diagnosis of a heart attack, and a cardiologist was not alerted.

At 10:30 pm, a second EKG showed infarction, and additional tissue damage appeared since the interpretation of the initial EKG.

The patient continues reporting severe pain with the administration of morphine and nitroglycerin. The physician's assistant diagnosed a heart attack at 1:30 am, and the cardiologist was contacted but not alerted to provide an emergency consultation.

The cardiologist did not arrive at the hospital until 9:00 am by which time the condition of the patient worsened with significant, untreated heart damage.

Transfer to another hospital was necessary to perform cardiac catheterization; during the procedure, the patient encountered cardiac arrest. Death resulted a few days later.

The plaintiff for the patient claimed that an emergency cardiac consultation and transfer for cardiac catheterization was necessary at both 10:30 pm and 1:30 am. As a result, the jury found in favor of the plaintiff.

DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Prompt Identification & Treatment of Cardiac Arrest is Essential to Reduce Complications & Improve Outcomes.

Prompt identification, administration of treatments, and the prevention of further tissue or death are necessary for patients that present in the emergency department with chest pain.

Early diagnosis also aids in the prevention or treatment of cardiac arrest, initiation of reperfusion therapy to limit the size or expansion of the infarct, and reduction or treatment of complications.

The EKG will reveal abnormalities even at an early stage, and subsequent testing will reveal the continuum of damage that has occurred.

In the absence of early treatment, the heart will continue sustaining an injury at the area where infarct occurred, tissue death will spread, and those areas will not receive proper blood supply and nutrients, preventing the heart from functioning properly.

Additionally, continuous telemetry would have alerted medical professionals of those changes occurring within the heart.

The INR is a periodic blood concentration test that determines the therapeutic effect of Warfarin - how effective or when to discontinue or adjust the medication.


Diagnosis & Treatment Protocol for Cardiac Arrest.

The patient reported severe chest pain of 10/10 with multiple doses of morphine and nitroglycerine.

Nitroglycerine is administered to patients who complain of chest pain because it widens blood vessels, which allows more blood to the area, with the attempt at reperfusion of the area.

The administration of both morphine and nitroglycerine did not relieve the patient's chest pain.

A diagnosis of a heart attack is suspected if the administration of nitroglycerine does not relieve chest pain. If nitroglycerine does not adequately relieve chest pain, the cardiologist should have been alerted and requested to consult the patient.


Medical Negligence:

The medical professionals responsible for his care were negligent and did not follow the standard of care model for presented chest pain.

The cardiologist and cardiac catheterization was a crucial factor in the prevention of subsequent damage that the patient sustained — multiple signs presented to alert the cardiologist immediately, which all were unnoticed or ignored.

The death of the patient was preventable with prompt treatment of the presented chest pain and following protocol for a heart attack.

Once the transfer for cardiac catheterization finally occurred, significant damage to the heart resulted in cardiac arrest.

Death resulted days later when the heart was unable to function effectively with the extent of the preventable damage.

DISCLAIMER: Dr. Dalawari shares interesting and relevant medical-legal case verdicts & settlements from the public record. He has no professional or personal relationship to the cases.

Do you have questions about a medical case or need help understanding treatment plans and options?

Cardio Med Legal Dr. Jasdeep Dalawari

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Jasdeep Dalawari MD

About Jasdeep Dalawari MD

Experienced General and Specialist Physician with a demonstrated history of working in the medical practice industry. Skilled in Interventional, Endovascular, Vascular, and General Cardiovascular Medicine; Emergency Medicine; Healthcare Consulting, including Peer Review, Expert Witness, and Utilization Review; and Medical Education. Strong healthcare services professional with an MS focused in Health Administration from Virginia Commonwealth University.