Accidentally injured a patient what should i do to protect myself?

[u/Disastrous-Panda-652]

Throwaway for privacy. Today at the emergency department was extremely busy, with only me, the senior resident, and the attending working. And then suddenly, the ambulance called and informed us that there was an accident involving three individuals, and they would be bringing them to us, all in unstable condition. When they arrived, the attending informed me that I had to handle the rest of the emergencies alone, from A to Z since he and the senior will be managing the trauma cases. And i only should call him when the patient is in cardiac arrest.

After they went to assess the trauma cases, approximately 30 minutes later, a patient brought by ambulance complaining of chest pain with multiple risk factors for PE and her Oxygen saturation between 50-60%. I couldn't perform a CT scan for her due to her being unstable so I did an echocardiogram instead looking for RV dilation.

Afterward, i decided to administer tPa and luckily 40mins her saturation started improving reaching 75-85%.

However, that’s where the catastrophe occured, approximately after 40mins post tPa her BP dropped to 63/32 and when i rechecked the patient chart turned out i confused her with another patient file and she actually had multiple risk factors for bleeding. She is on multiple anticoagulant, had a recent major surgery.

And due to her low BP i suspected a major bleeding and immediately activated the massive transfusion protocol as soon as I activated it, the attending overheard the code announcement and came to me telling me what the fuck is happening?

I explained to him what happened and the went to stabilize the patient she required an angioembolization luckily she is semi-stable now and currently on the ICU.

And tomorrow i have a meeting with the committee and i’m extremely anxious about what should i do and say?

[u/yeeehawthorne]

As someone whose grandma went from being extremely active (like kneeling in the garden every day yanking weeds) with an excellent memory to being confined to a wheelchair, hemiplegic, and unable to speak for the last 6 years of her life after inappropriately receiving tpa, please learn from this so you don’t repeat it again. Poor judgment calls happen to everyone, especially when you don’t have more experienced people looking over your shoulder. The best thing you can do is humble yourself and learn from your mistakes. Wishing you the best!

[u/rowrowyourboat → u/yeeehawthorne]

🫂

[u/Frequent_Cockroach_7 → u/yeeehawthorne]

This is a really generous response, and I second it. I am not a medical professional, but someone with a family member who was frequently hospitalized in later years... and I too feel for the position this resident was placed in.

From the description of what the resident did afterward, I think OP will be a good doctor, too. It shows honor to admit and learn from your mistakes, and as many other people here are noting, it also should help a (functioning) system self-correct.

Thank you, OP, for doing your best in not the best situation. There are many people here more knowledgeable than I am about best next steps, but I like the sound of what I hear: concerned, knowledgeable, uncompromising professionals, most of them indicating that disclosing the error fully is not only the right thing to do, but the expected thing.

(For all of those people saying this could never have happened, I think they have not been in rural hospitals--or rural areas, where cell phones may fail). And yes, there are rural hospitals with residencies. Some of these hospitals are small, like one near my parents' home, and some are surprisingly large for the communities they are in and have become regional hubs.)