Legal Medical Chronology
This is a writing sample from Scripted writer Lucas Benson
This document has been heavily redacted to comply with HIIPA regulations and standards. It is a document detailing the timeline of a wrongful death case for a personal injury law firm representing the victim's family. I compiled the document from thousands of pages of medical records and police/fire reports. It was used in trial in a case worth over $10 million dollars.
Medical Chronology
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Prepared by Lucas Benson, RN - Write On Wellness
NAME, F, XX yo, DOB: XXX, Deceased: XXX
NAME was a resident of XXX on XXX when she was administered another resident’s medicines by mistake, which included a dose of XXX. She was also administered her own regularly scheduled medicines at this time which included XXX. These drugs are contraindicated together as their combination can be lethally toxic, the effects of which exacerbated NAME pre-existing conditions.
Beginning early in the morning of XXX, NAME began to experience a drastic decline in condition including a critically slow heart rate and critically low blood pressure, along with complaints of difficulty breathing, nausea/vomiting, abdominal pain and general weakness. 911 was called and she was transported by emergent ambulance to the XXX ED where triage was completed.
The nurse who administered the incorrect medicine called the ED shortly after NAME arrived to inform them of the error and that the patient had incorrectly received a dose of XXX extended release. Treatment was enacted toward reversal of the toxicity with ineffectual results, the patient was intubated with an endotracheal tube and mechanical ventilation. XXX soon lost her pulse and CPR was required. Upon return of spontaneous circulation XXX was transferred to the ICU where she was stabilized but presented comatose and with poor lab results demonstrating irreparable major organ damage.
The following day, XXX, it was determined by the care team and family members, including the POA, that due to unpromising quality of life indicators, such as XXX, life supporting measures would be removed and care would switch to comfort measures only. XXX ultimately expired on XXX after X days in the hospital due to the combined drug toxicity of XXX.
Medical History:
Medical - XXX
Surgical - XXX
Allergies - XXX
Oral Medication List as of XXX per XXX:
XXX –
XXX –
XXX –
XXX –
XXX –
Synopsis of Pertinent Medical Encounters Leading to Detailed Events:
XXX had a history of XXX, XXX, XXX, and XXX. Her chronic XXX as well as surrounding hospitals beginning in XXX following multiple hospital visits for altered mental status and a general decline in condition. Medication non-compliance is noted as a causal element leading to XXX ongoing need for acute medical care and subsequent long term care needs, her XXXs/co-morbidities requiring critical attention to dosing amounts and scheduling to establish and maintain therapeutic value. Her XXX and XXX contributing frequently to her hospital admissions and rehab/long term stays.
Detailed Chronology of Events:
XXX – XXX – Med Center Records/Nurse Notes
XXXX – XX Fire Department Ambulance Report/Notes
PR - Police Report
XXXX - XXX Hospital Medical Center Records
XXXX - Office of the Medical Examiner Report
Date/Time: | Event: | Reference/Attribution: |
XXX | XXXX - seen by ED for xxx and xxx. Discharged to XXX with diagnoses of: XXX, XXX, XXX. | XXX, MD XXX, NP pg. 43-47 XXX |
XXX | Admit to XXX | pg. 41 XXX |
XXX | Admit to XXX for XXX | Dr. XXX, MD pg. 60 XXX |
XXX | Readmit to XXX | pg. 59 XXX |
XXX | Discharged from XXX to home health care | pg. 93 XXX |
XXX
| XXX resident Face Sheet Order Administration Records and Vital Signs viewed. | XXX, LPN pg. 2 XXX Audit Log |
XXX | Resident Face Sheet viewed by Director of Nursing XXX. | XXX, DON pg. 3 XXX Audit Log |
XXX | 911 call placed and dispatch notified. | XXX, XXX pg.28 XXFD |
XXX | Ambulance unit notified of Unconscious/Fainting/Near-Fainting patient at XXX, dispatched to facility. | XXX, XXX pg.28 XXFD |
XXX | Ambulance at XXX. | XXX, XXX pg.29 XXXX |
XXX | EMS assess patient, check temperature. | XXX, XXX pg.26 XXFD |
XXX | EMS check XXX. Stroke scale performed by EMS with XXX. | XXX pg.26 XXFD |
XXX | GCS test administered by EMS, patient within normal limits.
Vital Signs: BP: XXX HR: XX O2: XX% | XXX pg.26 XXFD |
XXX | EMS checks XXX | XXX pg.26 XXFD |
XXX | Primary Impression of XXX noted by EMS crew. | XXX pg.26 XXX |
XXX | XXX moved to stretcher and transferred to ambulance.
Heart Rate noted to drop to 34 beats per minute. | XXX pg.26/28 XXXX |
XXX | 12 lead EKG performed.
Cardiac rhythm noted to be irregularly irregular, patient in atrial fibrillation.
Could not get IV access after 2 unsuccessful attempts (indicative of low blood pressure). | XXX pg.26 XXXX |
xxx a.m. | Oxygen administered at a rate of 2 liters per minute.
(The ambulance record notes that the patient displays noticeable improvement in condition at this time with the administration of oxygen.) | XXX pg.26 XXXX |
xxx a.m. | EMS Departs XXX - MED CENTER. | XXX, XXX pg.29 XXXX |
xxx a.m. | Ambulance arrives at XXXX. | XXX, XXX pg.29 XXXX |
xxx a.m. | Covid Assessment Patient had received vaccine | pg. 12 XXXX |
xxx a.m. | Hospital Admission: Reason: XXX | pg. 12 XXXX |
xxx a.m. | Vital Signs: BP: 111/101 HR: 42 RR: 13 O2: 76% on 3L “(patient) feeling as though she can not breathe.” | XXX, MD pg. 17 XXXX
pg. 14 XXXX |
xxx a.m. | Abdominal Pain Assessment - patient noted to have mid to upper abdominal pain (6/10) this morning with one episode of vomiting, along with nausea and difficulty breathing.
Lungs assessed and noted to be diminished in the bases on both sides. Skin noted to be cool and clammy to touch with slight mottling. Patient noted to be restless and anxious.
Chest X-Ray stat - no acute infiltrate noted. | XXX, MD pg. 17, XXXX
pg. 21 XXXX
pg. 17,18 XXXX |
xxx a.m. | Continuous cardiac monitor placed on XXX.
Urinalysis ordered but not collected before discharge to ICU. | pg. 21 XXXX
pg.20 XXXX |
xxx a.m. | Temperature noted to be low at 95.9F. | pg. 17 XXXX |
xxx a.m. | Vital Signs: BP: 88/35 HR:43 RR: 22 O2: 100% on 3L | pg. 24 XXXX |
xxx a.m. | Nurse from XXX - MED CENTER (XXX ) called and indicated that the night nurse had accidentally given the patient XXXmg of XXX extended release.
Patient given aggressive IV hydration, blood pressure continued to drop.
Patient was given XXXto try and reverse toxicity of XXX.
Pt became unresponsive.
Patient intubated.
Patient became pulseless and CPR was started.
Patient admitted to ICU
Consulted with intensivist and poison control. | Noted start time of encounter with XXX, MD (From dictated note on same day at XXX p.m.) pg. 18 XXXX |
xxx a.m. | Medical History taken | XXX, MD |
xxx a.m. | Lab Results showing High and Low levels of blood chemistry including decreased red blood cell and hemoglobin count. | pg. 15 XXXX |
xxx a.m. (XXX - MED CENTER) | Prog Note added to XXX’s resident file at XXX - MED CENTER. | XXX, LPN pg. 259 XXX - MED CENTER |
xxx a.m. | Vital Signs: BP: 74/59 HR: 58 RR: 20 O2: 100% on 10L via Simple Mask | pg. 25 XXXX |
xxx a.m. | EKG-Atrial Fib with Slow Ventricular Response Critical Test Result | pg. 276 XXXX |
xxx a.m. | XXX(3.375gm/100mL sodium chloride) administered vias IV at 200mL/hr. | pg. 17 XXXX |
xxx a.m. | Continuous sodium chloride 10,000mL/hr begins via IV (aggressive fluid treatment as noted by Dr. XXX . Despite this patient BP continued to drop.) | pg. 16 XXXX |
xxx a.m. | Vital Signs: BP: 45/24 HR: 48 RR: 27 O2: 82% on 10L | pg. 25 XXXX |
xxx a.m. | Central Line prepped by Dr. XXX but never inserted | pg. 18, 32 XXXX |
xxx a.m. | Chest X-Ray due to weakness | pg. 275 XXXX |
xxx a.m. | XXX1gm/sodium chloride administered via IV 110mLs at rate of 110mL/hr.
(noted to be presumably directly after call from nurse XXX from XXX - MED CENTER to doctor about accidental dose of XXX.) | pg. 17 XXXX |
xxx a.m. | IV access initiated via right tibia. | pg. 32 XXXX |
xxx a.m. | XXX1mg/10mL administered via IV | pg. 16, 86 XXXX |
xxx a.m. | High troponin I level, 86.4, indicating a heart attack has occurred. | pg. 15 XXXX |
xxx a.m. (XXX - MED CENTER) | Prog Note added to XXX’s resident file at XXX - MED CENTER. | XXX , RN pg. 259 XXX - MED CENTER |
xxx a.m. | XXX 300mg administered via IV. | pg. 17, 86 XXXX |
xxx a.m. | Patient intubated. She kept saying “help me, I can’t breathe.”
Breath sounds diminished and coarse.
Endotracheal tube placed | Dr. XXX , MD pg. 406 XXXX
pg. 33 XXXX |
xxx a.m. | Mechanical Ventilation flow rate of XXLpm.
Vital Signs: HR: 36 O2: 75% on 15Lpm via mechanical ventilation. | pg. 29 XXXX |
xxx a.m. | XXX administered via IV starting dose/rate of 8mg XXX in 250mL of Normal Saline at 9mls/hr.
Vital Signs: BP: 67/54
2nd IV access initiated via left tibia. | pg. 16 XXXX
pg. 32 XXXX |
xxx-xxx a.m. | Chest X-Ray | pg. 17, 91, 273 XXXX |
xxx a.m. | Aggressive fluid treatment continued with sodium chloride 10,000mL/hr. | pg. 16 XXXX |
xxx a.m. | XXX 1,000mg/100mL administration started at 5mcg/kg/min, titrated per protocol. | pg. 89-90 XXXX |
xxx a.m. | Vital Signs: BP: 142/116 HR: 27
Patient lost radial pulse, pacer applied. | pg. 29 XXXX
Dr. XXX , MD pg. 29 XXXX |
xxx a.m. | Vital Signs: BP: 150/100 O2: 84% on 15Lpm mech. vent.
Paced beats, pacer set at 60. | pg. 29 XXXX |
xxx a.m. | Vital Signs: BP: 191/156 O2: 81% on 15Lpm mech. vent. Blood Pressure Mean of 167 | pg. 30 XXXX |
xxx a.m. | Left Internal Jugular Central Line access placed by Dr. XXX , patient still has low heart rate but had pulse. Once Dr. XXX places central line he notices no pulse, Code Blue called due to cardiac arrest. | pg. 32, 42, 59 XXXX |
xxx-xxx a.m. | No pulse. Code Blue called. CPR started. ED staff does chest compressions due to cardiac arrest.
SBAR report given to XXX, RN - ICU | Dr. XXX - Team Leader
Dr. XXX - Team Leader
XXX (presumably XXX) - Resp. Ther. - Airway
XXX - RN - Medications
XXX - paramedic
XXX - House Sup. - Recorder
XXX - RN - Monitor pg. 42, 52 XXXX |
xxx a.m. | BP: 136/0 HR: 0 CPR 1 round epinephrine administered and 1g calcium chloride administered. | pg. 51-52 XXXX |
xxx a.m. | No pulse, continued CPR. | pg. 52 XXXX |
xxx a.m. | Return of spontaneous circulation.
Vital Signs: BP: 88/53 HR: 69 RR: 22 O2: 89% on 15Lpm mech. vent. | pg. 30, 52 XXXX |
xxx a.m. | Transfer of patient to ICU admission is started. | pg. 92, XXXX |
xxx a.m. | Lab results continue to show High and Low levels of blood chemistry. Red blood cells, hemoglobin and others continue to drop or elevate toward critical values indicating worsening condition. Lactic acid noted to be elevated to critical level requiring dialysis. | pg. 15 XXXX
pg. 42-43 XXXX |
xxx a.m. (around) | Pt transferred to ICU
XX-year old with severe bradycardia went into cardiac arrest
Continuous telemetry monitoring ordered due to unstable arrhythmia. | XXX XXX , MD
pg. 95 XXXX |
xxx a.m. | Vital Signs: BP: 63/30 HR: 57 | pg. 291 XXXX |
xxx a.m. | Physical Exam notes weak pulse. | pg. 306 XXXX |
xxx a.m. | Blood pressure noted to be low at 97/44. | pg. 17 XXXX |
xxx a.m. | CVC Placement, right femoral A-line for hemodynamic monitoring.
Blood Sugar: 26 | Dr. XXX pg. 42, 59 XXXX |
xxx a.m. | ICU A&P Impression:
“XX-year-old who presents with severe bradycardia and went into cardiac arrest.
1. Acute hypoxic respiratory failure in setting of encephalopathy and severe bradycardia. Patient was intubated for altered mental status. On review of her chest Xray, she does not have any focal infiltrate. There is some patchy haziness. She is significant cardiomegaly. I do not think she has pneumonia. She could have hypercapnic respiratory failure. I waiting for the blood gases.
2. Severe bradycardia followed by cardiac arrest. She has severe bradycardia. Her underlying rhythm is atrial flutter and ventricular rate was 26. She was intubated. Post intubation, she went into cardiac arrest. She received 1 round of CPR and epinephrine. Currently her heart rate is in 60s and 70s. Is still in flutter. I will get Cardiology consultation. I will get an echocardiogram. It is most likely secondary to calcium channel blocker.
3. Cardiac arrest: CPR for 3-5 minutes. I wil try to keep her at a temperature of 35°-36 C.
4. Cardiogenic shock. Currently she is on vasopressors of XXX and XXX. Her lactic acid was very high when she presented to the hospital. I wil continue to follow. Central line has been placed. Echocardiogram will be ordered.
5. Encephalopathy toxic metabolic.
6. Acute kidney injury: Creatinine slightly high. We wil folow her kidney function.
7. GI and DVT prophylaxis.
8. Severe metabolic acidosis and lactic acidosis probably from hypoperfusion and shock. I increased the ventilator setting increase the rate. I wil start her on bicarbonate drip. Follow up the blood gases and chemistries.
I will send sputum cultures. I started her on antibiotic of ceftriaxone. Blood gases lab work have been ordered.” Patient is very critically ill with significant decompensation. I I was able to finally contact the family member which includes daughter Gina. to other family members. I explained her the condition and her prognosis.” | Dr. XXX pg. 49 XXXX |
xxx a.m. | XXX 1mg administered. | Standing Unit Order pg. 114 XXXX |
xxx a.m. | Dextrose 50% 25gm/50mL administered via IV. | pg. 16 XXXX |
xxx a.m. | XXX2,500mcg/50mL administered via IV. | pg. 114 - 116 XXXX |
xx a.m. | Lactic Acid lab ordered. | Dr. XXX pg. 120 XXXX |
xxx a.m. | Telemetry/EKG orders entered. | Dr. XXX pg. 111 XXXX |
xxx a.m. | Lactic acid lab result indicates patient is acidotic and will require dialysis for ongoing treatment. | pg. 120 XXXX |
xxx a.m. | XXX 400mg in 250mL Dextrose IV administration begins at rate of 40.05 mls/hr. | pg. 16 XXXX |
xxx a.m. | XXX2gm/100mL started via IV continuous at rate of 200mL/hr. | pg. 126 XXXX |
xxx a.m. | XXX titration to 124.9 mls/hr. | pg. 16 XXXX |
xxx a.m. | Echocardiogram due to cardiac arrest, respiratory failure and pulmonary hypertension. Noted findings: pulmonary hypertension, mitral, tricuspid and pulmonary valve insufficiency, mildly dysfunctional bilateral ventricular function, mild to moderate bilateral enlargement. | pg. 282-286 XXXX |
xxx a.m. | Sodium Bicarbonate 150 meq in 1,150 mls Dextrose administered via IV. 1,150 mls at 125 mls/hr. | pg. 121 XXXX |
xxx a.m. | EKG noted Atrial Flutter.
Indwelling urinary catheter applied. | pg. 278 XXXX
pg. 297 XXXX |
xxx a.m. | Chest X-Ray completed. | pg. 133 - 134 XXXX |
xxx a.m. | Vital Signs: BP: 110/70 HR: 101 RR: 22 Temp: 92.8F | pg. 302 XXXX |
xxx a.m. | Sodium Bicarbonate 50meq administered via IV | pg. 134 - 135 XXXX |
xxx a.m. | Vital Signs: BP: 130/119 HR: 109 RR: 21 Temp: 92.6F | pg. 302-303 XXXX |
xxx a.m. | Heparin administered subcutaneously. | pg. 16 XXXX |
xxx p.m. | Dextrose 50% 25gm/50mL administered via IV. | pg. 152 XXXX |
xxx p.m. | Chest and Abdominal X-Ray | pg. 269-271 XXXX |
xxx p.m. | Vital Signs: BP: 130/107 HR: 121 Temp: 92.3F | pg. 310 XXXX |
xxx p.m. | XXX titrated to 86.46 mls/hr. | pg. 16 XXXX |
xxx p.m. | XXX titrated to 76.67 mls/hr.
Endotracheal care performed by RT. | pg. 16 XXXX
pg. 312 XXXX |
xxx p.m. | XXX titrated to 67.25 mls/hr. | pg. 16 XXXX |
xxx p.m. | XXX titrated to 57.65 mls.hr. | pg. 16 XXXX |
xxx p.m. | Albuterol 3mL via inhaler for wheezing in the lungs while breathing. | pg. 15 XXXX |
xxx p.m. | Heart Rate noted to be high at 95 bpm along with high Respiration Rate at 21. | pg. 17 XXXX |
xxx p.m. | XXX 1,000 mg in 100 mL, dose of 4.79 mcg/kg/min, rate of 3.07 mls/hr. | pg. 16 XXXX |
xxx p.m. | XXX2,500 mcg in 50 mL administered via IV at rate of 0.5mL/hr.
Changed status from Full Code to Do Not Resuscitate | pg. 16 XXXX
Dr. XXX pg. 142 XXXX |
xxx p.m. | XXX titrated to dose of 9.6 mcg/kg/min at rate of 6.15 mls/hr. | pg. 16 XXXX |
xxx p.m. | Vital Signs: BP: 77/47 HR: 37 Temp: 92.1F | pg. 314 XXXX |
xxx p.m. | Heparin administered subcutaneously. | pg. 16 XXXX |
xxx p.m. | EKG noted Atrioventricular Block. | pg. 278 XXXX |
xxx p.m. | Increase sodium bicarbonate to 150mL/hr. | pg. 143 XXXX |
xxx p.m. | Lactic Acid lab completed. | pg. 145 XXXX |
xxx p.m. | Vital Signs: BP: 69/50 HR: 54 Temp: 91.5F | pg. 323 XXXX |
xxx p.m. | Lactic Acid lab completed. | pg. 153 XXXX |
xxx p.m. | Telemetry/EKG frequency changed to every 4 hours. | pg. 111 XXXX |
xxx p.m. | Vital Signs: BP: 97/53 HR:56 | pg. 334 XXXX |
xxx p.m. | Lactic Acid lab completed | pg. 145 XXXX |
x/x/xxxx |
|
|
xxx a.m. | Abnormal EKG result - Intraventricular conduction delay | pg. 277 XXXX |
xxx a.m. | Lactic Acid lab completed | pg. 146 XXXX |
xxx a.m. | Vital Signs: BP: 98/49 HR: 55 RR: 27 | pg. 342 XXXX |
xxx a.m. | EKG completed | pg. 155 XXXX |
xxx a.m. | Vital Signs: BP: 112/44 RR: 24 | pg. 349 XXXX |
xxx a.m. | Morning labs collected. | Dr. XXX pg. 104 - 106 XXXX |
xxx a.m. | Patient has very low Mean arterial Pressure. | pg. 407 XXXX |
xxx a.m. | Vital Signs: BP: 110/47 RR: 24 | pg. 351 XXXX |
xxx a.m. | Famotidine 20mg administered via IV. | pg. 97 XXXX |
xxx a.m. | Sodium bicarbonate 100meq administered via IV | pg. 158 XXXX |
xxx a.m. | Lactic Acid lab completed | pg. 147 XXXX |
xxx a.m. | EKG noted Sinus Tachycardic and Arrhythmia HR: 113 | pg. 280 XXXX |
xxx p.m. | Vital Signs: HR: 120 | pg. 359 XXXX |
xxx p.m. | Vital Signs: BP: 107/61 HR: 114 RR: 23 O2: 82% mechanical ventilation
“Off sedation for a few hours, completely unresponsive.” | XXX , DO pg. 57 XXXX |
xxx-xxx p.m. (about) | Conversation with XXX at bedside regarding poor prognosis. Care is futile w/o dialysis. POA makes decision to not elevate treatment. Family is hoping to get a couple more family members at hospital to say goodbye prior to withdrawing care.
Assessment: Severe bradycardia with cardiac arrest Alleged accidental overdose of XXX Acute hypoxemic respiratory failure due to above Ventilator dependence due to above Cardiogenic shock due to above Severe/critical lactic acidosis due to the above Anuric acute renal failure Probable anoxic encephalopathy | XXX , DO pg. 53, 56 XXXX |
xxx p.m. | Vital Signs: HR: 139 O2: 79% on mech. vent. | pg. 363 XXXX |
xxx p.m. | EKG noted Atrial Fibrillation. HR: 119 | pg. 280 XXXX |
xxx p.m. | Family has decided to proceed with withdrawal of care when family arrived. | pg. 407 XXXX |
xxx p.m. | Vital Signs: BP: 100/58 HR: 123 RR: 24 | pg. 369 XXXX |
xxx p.m. | Vital Signs: BP: 79/47 HR: 108 RR: 31 | pg. 370 XXXX |
xxx p.m. | Vital Signs: BP: 90/56 HR: 140 RR: 29 O2: 72% mech. vent. | pg. 370 XXXX |
xxx p.m. | Heart rate noted to be in the 150s, provider notified, verbal orders for metoprolol and amiodarone. | pg. 407 XXXX |
xxx p.m. | Metoprolol 5mg administered via IV | Dr. XXX pg. 159 XXXX |
xxx p.m. | Amiodarone bolus dose along with IV admin. 450mg in 250mL D5W at 1mg/min, titrate down after 6 hours. | pg. 160 - 161 XXXX |
xxx p.m. | EKG noted Tachycardic HR: 121 | pg. 281 XXXX |
xxx p.m. | Low Mean Arterial Pressure noted in the 50s. Provider notified, order for albumin. | pg. 407 XXXX |
xxx p.m. | Albumin Human 5% 1,000mL at 500mL/hr started (stopped at XXX p.m.). | Dr. XXX pg. 164 XXXX |
xxx p.m. | Vital Signs: BP: 79/51 HR: 134 | pg. 376 XXXX |
x/x/xxxx |
|
|
xxx a.m. | Vital Signs: HR: 115 O2: 64%
EKG noted Atrial Fibrillation. HR: 122 | pg. 381 XXXX
pg. 281 XXXX |
xxx a.m. | Vital Signs: BP: 87/52 HR: 120 O2: 67% mech vent. | pg. 384 XXXX |
xxx a.m. | EKG noted Atrial Fibrillation. HR: 101 | pg. 281 XXXX |
xxx a.m. | Vital Signs: BP: 64/40 HR: 98 | pg. 389 XXXX |
xxx a.m. | Vital Signs: BP: 74/44 HR: 83 | pg. 397 XXXX |
xxx a.m. | Just waiting for family to say goodbye to withdraw care. | XXX , DO pg. 54 XXXX |
xxx p.m. | Vital Signs: BP: 68/40 HR: 77 | pg. 398 XXXX |
xxx p.m. | Morphine 4mg and Ativan 2mg started as final comfort measures. | pg. 166-167 XXXX |
xxx p.m. | Vital Signs: BP: 59/36 HR: 80 | pg. 401 XXXX |
xxx p.m. | Patient died Cause of Death XXX
Due to combined drug toxicity of XXX, XXX, and XXX. | pg. 288 XXXX
pg. 1-2 XXXX pg. 6 PR |
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