MedBugs: SAQ #463

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Case: Open disclosure

A registrar in your Emergency Dept has attempted to place a central venous catheter (CVC) in the internal jugular vein of a patient in septic shock. You become aware that a procedural error has occurred when the emergency alarm is sounded and you find the registrar applying pressure to the neck of the patient. They state “I think I punctured the carotid artery and the patient is having a stroke”. A rapid examination confirms the registrar’s suspicions.

1. State (4) specific IMMEDIATE priorities, aside from an open disclosure discussion, on your arrival to the resuscitation cubicle. (4 marks) 4 marks

2. List (5) benefits of open disclosure approach to clinical procedural errors. (5 marks) 5 marks

3. List (3) examples of a sentinel event. (3 marks) 3 marks

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Case: Open disclosure

1. State (4) specific IMMEDIATE priorities, aside from an open disclosure discussion, on your arrival to the resuscitation cubicle. (4 marks) 4 marks

2. List (5) benefits of open disclosure approach to clinical procedural errors. (5 marks) 5 marks

3. List (3) examples of a sentinel event. (3 marks) 3 marks

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