However, she was also recovering from injuries suffered in an auto collision and seeing Scott Spurrell, a massage therapist who had learned acupuncture during a weekend course at a local university. She was suffering from pounding headaches, and Spurrell convinced her that he could relieve those headaches by inserting a two inch needle, according to the disciplinary ruling, into a muscle located between the clavicle bone and ribs. From the description, its not clear to me exactly which muscle they meant, although it could conceivably have been the scalenes, the sternocleidomastoid, or perhaps even just the pectoralis major. Whatever muscle Spurrell was targeting, going between the clavicle and the ribs is basically where surgeons stick the needle when trying to place central venous catheter into the subclavian vein, and, yes, a pneumothorax is a known potential complication of placing such lines. What also puzzles me is how on earth Spurrell could have stuck the needle in deep enough to cause a pneumothorax? It would be one thing if Ribble-Orr were a fragile little old lady, but she wasnt. She was an athlete, presumably with well-developed musculature. It would take a lot to get a needle through all of that muscle to get to the pleural cavity. As can happen from a pneumothorax, even in a healthy person, Kibble-Orr developed pneumonia and required a thoracotomy. To be honest, its not clear from the account provided why she needed a thoracotomy, but its clear that the pneumothorax led to a cascade of complications, as described: Shortly after leaving the clinic, Ms. Ribble-Orr began having difficulty breathing, chest pain and a grinding sensation. She returned to the therapist later, wondering if she had suffered a pneumothorax. He told her it was more likely a muscle spasm, but said she could go to the hospital if she felt it was more serious or if the symptoms worsened. The next morning, she did feel worse and finally headed to the emergency department. Ms. Ribble-Orrs lung had indeed collapsed and she spent the next two weeks in hospital, as a serious lung infection and then a blood infection followed. She was left with just 55% function in one lung. One notes that if you do not have the knowledge to recognize symptoms and signs of potential complications resulting from your treatment, you have no business administering that treatment. It used to be that if you didnt know how both to recognize and treat potential complications of your treatment, you shouldnt be administering that treatment, but those days are gone. For instance, gastroenterologists do colonoscopies, even though they are not able to repair the inevitable (and thankfully uncommon) colon perforations that are a recognized risk of the procedure. But they can recognize the signs and symptoms. They know how to diagnose a potential perforation and when to call a surgeon to fix it. Spurrell was clearly utterly clueless, basically dodging responsibility by telling Kibble-Orr that she could go to the ER if she wanted to. Obviously, he didnt think that she needed to. What should have happened, if Spurrell knew what he was doing, was a quick physical exam, which likely would have diagnosed a significant pneumothorax, through decreased breath sounds or and elevated diaphragm on the affected side, or both.
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