by MONACHORUM

I refer to your recent report regarding the sad loss of Baby Yok Shan’s left arm following an antibiotic infusion into the premature baby’s limb that went wrong.

Pictures and follow-up reports of the baby’s condition and arm were published nationwide. It was obvious that the left forearm was gangrenous with the margins showing features of acute infection.

As reported this could have been the result of an intravenous infusion that extravasated at the level of the elbow causing compartment syndrome, cutting off blood supply further down the forearm, giving rise to the gangrene and subsequent infection.

Alternatively, it could also be possible that the doctor who inserted the IV, could have done so directly into the brachial artery which is the main artery that supplies the forearm. An injection such as vancomycin into this artery could result in disastrous circumstances including obvious shut-off of blood supply and death of tissues that this artery supplies.

A remote and far more unusual way of inflicting infection would be to actually insert the IV needle intraosseously (into the bone) also at the level of the elbow which will result in infection of the bone or rarely pulmonary embolism transmitted via the marrow. Gangrene is an unusual occurrence.

It was reported that the findings of a committee formed to look into the mishap found that the gangrene was the result of an injection given by an unsupervised house-officer and a pediatrician who was consulted only by phone which is not unusual if the pediatrician had been on-call too frequently. Read the rest of this entry »