discipline summaries are evident in the patient and are often signs of impending respiratory failure . Moderate to severe croup is treated usually with corticosteroids and nebulized Epinephrine , and Dr . X was concerned that this was not given as a first line of treatment since this patient showed significant respiratory distress . The steroid drugs that were given could take up to six hours to take effect . Dr . X also questioned the use of oral Prednisolone in a critically ill child with severe respiratory distress rather than using a more potent steroid such as Dexamethasone which can be given as a smaller volume orally or by injection . Because this patient was so ill , Dr . X thought that an injection should have been given . In his assessment of this case , Dr . Y notes in his report that the medication used , bronchodilators and inhaled steroids ( Ventolin and Atrovent ), are somewhat atypical . Racemic epinephrine is the new standard , Dr . Y testified , and would have been the standard in 2011 . More and more research is being done and it is still being discussed at conferences . The use of Ventolin and Atrovent is discouraged because it has increasingly been found that it does not make a difference , according to Dr . Y ’ s testimony . He went on to say that the research shows that Ventolin and Atrovent do not actually help for croup and it is the nebulized cool mist that it is administered in that has some effect . Dr . Kamermans also said that the cool mist itself worked well for croup . Dr . X interviewed Dr . Kamermans about his care of this patient and concluded that Dr . Kamermans did not recognize the severity of the child ’ s presentation to the ER with respiratory distress , and in particular , the potential for deterioration upon transfer to another facility with primary care land medics . The care of this patient by Dr . Kamermans did not meet the standard for a physician practising in emergency medicine according to Dr . X . Despite his comments about Epinephrine being the usual medication used for croup , Dr . Y reported that the care that Dr . Kamermans provided was a reasonable standard of care . In Dr . X ’ s view , Dr . Kamermans ’ clinical handling of this case also demonstrated a lack of knowledge and judgment regarding an appropriate ER evaluation to determine the cause of the patient ’ s complaint and to treat the complaints . His handling of the case had the potential to expose the patient to harm or injury .
Transfer of an ill child Following his interview with Dr . Kamermans , Dr . X opined that Dr . Kamermans did not recognize the severity of the child ’ s symptoms and in particular the potential for deterioration upon transfer to another facility with primary care ambulance medics . He was concerned that if the child got into more severe respiratory problems , the paramedics would not have the training to maintain the child ’ s airway en route to the hospital that Dr . Kamermans testified was 30 to 40 minutes away . Dr . Kamermans ’ care of this patient failed to maintain the standard both in terms of documentation and treatment of this sick child . Dr . Kamermans used medication that is not helpful with croup and he was not up to date with the current medication standards at the time . He used medications that he was familiar with . Dr . Kamermans demonstrated a lack of knowledge and judgment in this case with regard to the treatment of croup and his care failed to maintain the standard of practice .
Patient # 5 Patient # 5 was a child who was brought to Emergency with a history of possible antifreeze ingestion . Dr . Kamermans failed to maintain the standard of practice and was cavalier in the treatment of this patient . Dr . Kamermans appropriately obtained information from the Poison Control Centre but did not use it . He failed to order the recommended blood work , he failed to order an adequate observation period , and he assumed the child had not ingested much without any grounds to make that assumption , and he failed to appreciate the serious risk to the child of ingesting even a small amount . It was the Committee ’ s view that Dr . Kamermans ’ knowledge and judgment deficiencies persist with respect to how to properly address the issue of the ingestion of antifreeze by a child . Dr . X ’ s report stated the patient was brought to the
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Issue 1 , 2017 Dialogue 57