Case introduction of delayed rescue of medical malpractice due to penicillin allergy Yu, a male, aged 30, went to the hospital for cough, expectoration and general fatigue. The doctor diagnosed his upper respiratory tract infection and prescribed penicillin for him to drip intravenously. The patient brought penicillin and drops from the hospital home for Sun Mou in the village to inject. Sun, a graduate of provincial medical college, returned to his hometown after obtaining the qualification of doctor. He often gives infusion to patients at the invitation of villagers, charging a small fee each time. When villagers saw that Sun's fee was low, they could have an infusion at home, which not only saved hospitalization expenses, but also saved manpower. So more and more people come to him for infusion. Sun saw the patient bring penicillin back from a certain place, first looked at the skin test results, which were negative, and quickly gave him an intravenous drip. After infusion 15 minutes, the patient developed chills and cold sweat. According to his past experience, Sun thought it was a general infusion reaction, so he was injected with adrenaline. Five minutes later, a wife saw that her condition had not improved and said, "If not, go to the hospital!"! However, Sun believes that the adrenaline he used has not yet reached the therapeutic effect, and proposed to let his family observe it for a while. After another 15 minutes, the patient did not get better, but gradually got worse, with symptoms such as lip, hairpin, dyspnea and cold limbs. The family once again proposed to go to the hospital. Sun agreed this time. Unfortunately, when he arrived at the hospital, the patient was already dead. Hospital diagnosis: penicillin died of anaphylactic shock. After a certain death, his wife suggested that Sun did not let the patient go to the hospital in time, which delayed the rescue time and led to the death of the patient. Sun said that he injected adrenaline into the patient to prevent anaphylactic shock, and the rescue was timely and correct, and there was no problem of delaying the rescue. As for not letting the family members go to the hospital for the first time, Sun believes that since the patient had a skin test, it would not be a shock caused by penicillin allergy, but a general infusion reaction. Sun has already dealt with this reaction, so he thinks it can be handled this time, and there is no need to go to the hospital. 15 minutes later, Sun thought that the adrenaline he injected should work, but his condition still did not improve, and he realized that this was not an ordinary infusion reaction and he should go to the hospital. As for penicillin skin test negative, but anaphylactic shock still occurs during the injection process, Sun suggested that this situation is relatively rare and difficult to predict and prevent. Even in the hospital, this kind of anaphylactic shock is difficult to rescue successfully. Therefore, Sun believes that the patient's death was an accident, and he is not responsible for this incident. As a result, the court not only ordered Sun to pay tens of thousands of yuan in economic compensation to the family of the deceased, but also investigated his criminal responsibility. The lawyer commented that this case is a typical case of penicillin allergy leading to the death of patients. In general, if penicillin is negative after skin test, penicillin should be considered. However, in practice, we occasionally encounter penicillin allergic reaction when the skin test is negative, which is called medical malpractice in medicine. Medical malpractice The so-called medical malpractice refers to the unexpected and unforeseeable adverse consequences of personal injury to patients due to their special illness or physique in medical care. The second and third cases are medical accidents in the Regulations on Handling Medical Accidents, which are not medical accidents. The elements that constitute a medical accident are as follows: (1) Medical personnel have caused personal injury to patients in medical activities. If this consequence does not occur in the process of diagnosis and treatment, it does not belong to the scope of medical malpractice discussion. If a patient dies on the way to the hospital, or a healthy person is run over by a car on the road, it is not a medical accident. (2) The adverse consequences of personal injury of patients are unpredictable and unpredictable by medical staff. The so-called unforeseeable means that according to the situation at that time, medical personnel could not foresee the consequences of such damage. In other words, there is no subjective fault of medical staff in the occurrence of these adverse consequences. This is the main difference between medical accidents and medical errors. (3) Adverse consequences of personal injury to patients. Objectively speaking, with the result of patient damage, we can discuss whether it is a medical accident or a medical accident. Without the above harmful results, even if there are medical nursing mistakes, they will be discussed separately, either medical mistakes or successful treatment. Therefore, none of the above three aspects can constitute a medical accident. Medical accidents often occur in practice: sudden death of coronary heart disease occurs when treating cardiovascular diseases, and primary cardiac arrest occurs when doing electrocardiogram examination, and doctors fail to take measures to revive patients, resulting in death of patients; When treating vascular diseases, it causes blood embolism; Thereby leading to the death of the patient; In the puncture diagnosis of patients with arteriosclerosis, the retrograde rupture of aortic dissection leads to the death of patients and so on, which belongs to medical accidents. During anesthesia, when the prescribed dose of anesthetic is used in basic anesthesia or spinal block anesthesia, it still leads to respiratory depression, blood pressure drop or high anesthesia level. Although actively rescued, it still failed to prevent adverse consequences, which is an anesthesia accident; In principle, general anesthesia is prohibited within 4 hours after the patient is admitted to the hospital. In case of emergency patients with full stomach, general anesthesia operation must be performed immediately, and preventive measures have been taken as much as possible, but vomiting, reflux, aspiration and even asphyxia cannot be avoided during general anesthesia, which is a medical accident. During the operation, the examination and approval procedures for new and large-scale operations were not fulfilled as required, and all important links of the operation were correct, but adverse consequences such as embolism of important organs and secondary bleeding occurred, which was an accident; The condition is critical and the operation is urgently needed. The operation is correct, but the death during the operation or the serious sequelae after the operation are accidents. The patient has a specific constitution, which is known before operation or found after operation, but this is an accident that is difficult to be solved by current medical technology. The skin test was carried out according to the routine requirements during infusion, and it was confirmed that the skin test result was negative after careful judgment, but the patient still died after taking the medicine; The patient has allergic reaction during continuous medication, or the skin test has not been repeated within the prescribed time limit; Drugs that cause allergic reactions are not the object of unified regulations such as skin tests or other preventive regulations. It is a medical accident. Acupuncture treatment is accurate in positioning and operation, and the patient is in a state of shock and coma due to his own illness. In the process of acupuncture treatment, the mental stress of patients makes the cerebral cortex function disorder and out of control, thus producing cancer reaction; It is an accident to treat spinal fracture caused by schizophrenia with electroacupuncture plus pumping. The medical accidents in the process of various examinations include: although the medical staff operated according to the operating rules of retrograde cholangiography with membrane choledochoscope, there were still duodenal perforation and contrast agent leaking into the intestinal wall; Renal angiography was performed according to the regulations, and renal failure was caused by renal damage during intravenous injection; Although the medical staff operate carefully according to the rules, after repairing or replacing the diseased blood vessels with artificial blood vessels, there are still symptoms such as cancer, infection, thromboembolism and vasculitis, which are all medical accidents. In this case, according to the routine, the allergic reaction caused by negative skin test is what medicine calls medical malpractice. The reason why the court in this case refused to deal with the medical accident was that Sun did not have the qualification of a medical practitioner and belonged to illegal medical practice. Although the initial cold sweat and chills are somewhat similar to the blood transfusion reaction at that time, symptoms such as dyspnea, cramps in lips and limbs are typical manifestations of penicillin allergy. For the rescue of penicillin anaphylactic shock, the application of epinephrine is appropriate, and it is indeed timely from the situation at that time. As soon as the patient had chills and cold sweat, Sun injected the patient with adrenaline. Although Sun didn't realize that allergic shock was caused by penicillin at that time, the treatment was correct. Therefore, from the use of adrenaline, Sun did not delay. However, the rescue measures of cyanotoxin allergy are not only adrenaline injection, but also oxygen inhalation, respiratory center stimulant, intracardiac injection, chest massage and other measures. If these measures can't keep up, the patient may die after being rescued. Sun does not have other rescue conditions, so it is impossible to say that he did not delay the rescue opportunity. As for the problem that Sun said that this kind of anaphylactic shock is difficult to rescue successfully, it is indeed a fact. However, Sun is not sure whether this patient will be one of the few people who has been successfully rescued. That is to say, through timely and comprehensive rescue, it is entirely possible for him to survive. Therefore, Sun can't get rid of his responsibility, because it is difficult to successfully rescue this shock. The reason why the court finally sentenced Sun to criminal responsibility was that he did not have the conditions for "illegal medical practice". It can be said that if Sun has a doctor's license and is infusing fluids for patients in a regular hospital, even if an allergic reaction occurs and has certain damaging consequences, it can only be treated as a medical accident. Because when there is an emergency in the process of infusion, what medicine to use and what method to rescue it are all decided by the doctor, and the nurses in the hospital only need to carry out the doctor's orders. But unfortunately, Sun's infusion behavior did not happen in the hospital, but in the patient's home far away from the hospital. In this way, Sun not only plays the role of a nurse, but also shoulders the heavy responsibility of a doctor. Even if there is an accident, he can only decide what medicine to use and how to save it. From this perspective, Sun actually played the role of a nurse and a doctor. Since Sun is also a doctor, he should be responsible for the adverse rescue. It is irresponsible for Sun himself to give infusion to patients when he does not have the rescue conditions. Moreover, when the patient developed premenstrual symptoms, he did not send the patient to the hospital as soon as possible, but thought he could be rescued, thus delaying the rescue opportunity.