Savita's final hours reveal system failure at Irish Hospital

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Savita Halappanavar
New Delhi, April 12: While the inquest into the death of Savita Halappanavar in Galway, Ireland, points to 'system failure', the deposition of a nurse speaks about the final hours of Savita. It also revealed that there were eight retrospective entries made to her records at Galway University Hospital.

According to local media, intensive care unit nurse Jacinta Gately spoke about Savita's condition when she came on duty at 8pm on October 27. At that time Savita's "non-invasive blood pressure was unrecordable", her heart rate was 150-55 beats per minute (bpm), she was intubated, ventilated and sedated with morphine.

At about 9 pm an arterial line was inserted and Savita's heart rate occasionally dropped from 150bpm to 90bpm, she said. Her blood pressure was very low.

"Adrenaline and noradrenalin infusions were increased until her blood pressure improved." Tests found her blood lactate levels were now "very high" at 24, up from eight on Thursday morning and grossly exceeding desirable levels of 1.5. The high lactate levels were an indicator of sepsis and anything above four was an indicator of sepsis. And Savita's report showed that it was 24.

Jacinta Gately says: "Ms Halappanavar was unresponsive during this time, her pupils were very sluggish, size 4-5 and there was no response to stimuli. She was very oedematous, fingers flexed tightly, feet extended and very stiff.

Her abdomen was very distended." The nurse also noticed that there was heavy vaginal bleeding.

At about 10pm, she said, alarms on the ventilator began ringing. Savita was given an intravenous infusion of cistatracurium, a drug to relax her skeletal muscles in an effort to help her breathe.

At 11 pm, Savita unresponsive. A system to monitor her level of consciousness found her at between one and four, when ‘awake' levels would be 100. Her blood pressure remained very low, while her lactate levels were continuing to rise.

At 11.45 pm, sodium bicarbonate, dextrose and insulin were infused in an effort to treat rising potassium levels and her abnormal heart rhythms.

Between 12.30am and 12.45am the monitor showed her heart rate becoming chaotic, with a "broad spectrum rhythm".

"Pulses were checked. None were palpable. CPR commenced by Dr Aoife Quinn, staff nurses Veronica Rafftery, Therese Connolly, Jeurgen Schone, Áine Nic an Bheath and myself," she said.

"CPR continued until after 1.15 when a decision was made to cease compressions as Savita Halappanavar was not responding to our efforts. Her husband Praveen Halappanavar informed that his wife was unresponsive and that she had passed away. Time of death recorded at 01.09 hours.

Meanwhile, it has been revealed that the inquest has heard that there were eight retrospective entries made to her hospital records.

The corner was told five of the medical notes were written within an hour or so of the events happening. A further three were made in November.

Because this was first death due to maternal complications at the hospital in 17 years, Declan Buckley, who is acting on behalf of the hospital and its staff, said this was done in an attempt to remedy any shortcomings in the notes about a serious tragedy.

Buckley said he could not explain one retrospective entry relating to the 24 October, the day Savita Halappanavar developed severe sepsis.

The day-wise break up and doctors not following rules and procedures:

October 24 (Wednesday):

When Savita is asleep, her condition is not checked every four hours, as required by hospital policy.
Savita and her husband sleeping on the floor of her room and complain of cold. She is given a blanket but her heart rate is not taken.

Consultant obstetrician, Dr Katherine Astbury, visits Savita. She does not read the notes herself and is not told by her team about the reference to the foul-smelling discharge. She expresses concern that she has chorioamnionitis, but orders tests to rule out a urinary tract infection.

The doctor diagnoses sepsis, as opposed to severe sepsis, because Savita's blood pressure is not low. She tells the inquest that the information about the foul-smelling discharge is significant and had she known, she would have terminated sooner.

Savita's lactate level - an indication that she is going into shock - is also tested but the test is rejected because it's in the wrong bottle. The ward is not informed of his.

1 pm: Dr Astbury told about Savita's deteriorating condition. She decides, after consulting a senior colleague, to carry out a termination. However, a scan reveals the foetal heartbeat has stopped.

3.15 pm: Savita is moved to theatre. During insertion of a central line, she spontaneously delivers a dead baby girl.

October 25 (Thursday):

3 am: Savita is transferred to intensive care unit because of septic shock.

October 26 (Friday):

Savita's condition deteriorates. Blood tests reveal septicaemia due to E.coli ESBL.

8 pm: Dr Astbury visits Savita for the last time. She is critically ill.

October 27 (Saturday):

Savita's condition deteriorates further and doctors do not expect her to survive.

October 28 (Sunday):

12.45 am: Savita suffers cardiac arrest.

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