A mother died after going to A&E with a “headache”, an inquest heard.
Inga Rublite, 39, arrived at Queen’s Medical Centre, part of Nottingham University Hospitals, shortly after 10.30pm on January 19, after being advised by a 111 doctor to do so because of “pain with a sudden head.”
A senior QMC consultant admitted there was a “missed opportunity” in the assessment of the woman who waited more than eight hours in the Emergency Department and was found unconscious under a coat.
The mother of two, originally from Latvia, developed a headache around midday the same day while on a video call.
Following the advice she received during the 111 call, a neighbor took her to the emergency room and she had her initial nursing triage at 10:55 p.m.
An inquest into her death held on July 24 at Nottingham Council House was told how Mrs Rublite’s neighbor left hospital at 1.30am.
The woman was then seen at 2:07 am for some observations and was called by the team at 4:30 am, 5:26 am and again at 6:50 am, when she was discharged from the system.
As there was no response, it was assumed that she left the department due to the long wait.
However, she was found in the waiting room with a coat over her head lying in front of the chair at around 7am on January 20th.
She was unresponsive and had a seizure and vomited.
After being found, she was “immediately attended to” by an experienced doctor, her seizures were treated and she was placed in a medically induced coma.
Tests revealed that she had poor air intake and an elevated heart rate and blood pressure.
A series of investigations were then carried out, including a complete blood count as well as a head CT scan.
The examination revealed a large hematoma – a collection of blood – and neurosurgery and intensive care teams were called to provide care.
The neurosurgical registrar noted that Ms Rublite had “significant and unsustainable brain damage” which could not have been corrected by surgical intervention.
She was transferred to the ICU and her family and friends were told that she “had suffered a major head bleed, which led to a significant increase in pressure inside her head” and that she was “not expected to survive despite our best efforts.” efforts.”
‘DEVASTATED’ FAMILY
They were “devastated” by the news and she ended up dying shortly before 10:30am on January 22nd.
The cause of death was given as spontaneous subarachnoid hemorrhage secondary to a ruptured aneurysm of the middle cerebral artery.
There was no post-mortem examination in this case as there was “no doubt” as to the cause of death.
The hearing held on Wednesday was told that the waiting room was full, with Dr Robert Jamieson, consultant, saying during his evidence that “we never fail to be full”.
What is a subarachnoid hemorrhage?
Subarachnoid hemorrhage is an uncommon type of stroke caused by bleeding on the surface of the brain and is a serious condition that can be fatal. National Health Service it says.
There are usually no warning signs, but a subarachnoid hemorrhage sometimes occurs during physical exertion or exertion, such as coughing, going to the bathroom, lifting something heavy, or having sex.
The main symptoms you need to be aware of include:
- a sudden severe headache unlike anything you’ve ever experienced before
- a stiff neck
- feeling and getting sick
- sensitivity to light (photophobia)
- blurred or double vision
- stroke-like symptoms – such as slurred speech and weakness on one side of the body
- loss of consciousness or convulsions (uncontrollable shaking)
Subarachnoid hemorrhages are often caused by a ruptured blood vessel in the brain (a ruptured brain aneurysm).
It is not known exactly why brain aneurysms develop in some people.
But certain risk factors have been identified, including:
- smoke
- high pressure
- excessive alcohol consumption
Severe head injuries can cause subarachnoid bleeding, but this is a separate problem known as traumatic subarachnoid hemorrhage.
He added that “the opportunity to see what she was like, what she looked like” was lost.
Dr Jamieson told the court: “There are standards and targets being asked for which cannot be achieved by the NHS.
“Anesthesia needs to be performed within time limits, the same for ECGs.
“Every patient with chest pain needs to have an ECG within 30 minutes [of arrival]every patient needs oxygen regularly and all of this suddenly becomes unattainable.”
When asked what measures have been implemented to optimize patient calls in the emergency department waiting room by coroner Elizabeth Didcock, Dr Luke Derby, emergency department matron, said a tannoy system will soon be installed to make more easy for people to hear their name being called.
At this time, as was the case in January, patients are called by voice.
The court was told that Ms Rublite could not be seen by the doctor calling out patients’ names whilst sitting on the side of a corridor.
The side of the hallway where she was standing has five or six chairs and charging boxes.
Dr Jamieson said: “People sleeping in the emergency room is something that is not unheard of.
“There are a lot of homeless people who come and sit in the department.
“About 6 percent of patients leave before being seen.
“Staff see patients putting the coats on their heads daily.”
DELAY IN VERIFICATION
The trust accepted that there was a delay in carrying out a scan to diagnose bleeding on Ms Rublite’s brain, which would have been noticed on examination.
“On the balance of probabilities it is accepted that the bleeding would have been seen on the CT scan,” Dr Jamieson told the court.
Coroner Didcock added that additional questions during triage could have added weight in making doctors understand the severity of the headache.
The hearing was told that Ms Rublite had never had a brain scan in her life and that there was no clinical need for this to be done.
She also had no history of headaches, however, her headache on January 19th left her unable to move her head or stand up, experiencing severe pain throughout her head, neck and jaw.
HEADACHE ‘THUNDER’
She described it as a “thunderclap” headache and took two doses of paracetamol at around 3pm that day, to no avail.
The inquest was told that a set of observations were carried out at 10.58pm and Ms Rublite was “alert, awake, in mild pain”.
Another set of observations were made at 2:07 am and his heart rate increased from 86 to 106 bpm previously.
At that moment, Rublite was “alert, awake, without nausea and in severe pain”.
A nurse stated that Ms. Rublite was called on her cell phone after she failed to respond to three calls in the waiting room, but her sister, Inese, who was present at the hearing, said that there is no record of the call on Ms. Rublite’s phone. . Rublite.
The investigation continues.
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