Debate over the method and amount of adrenaline given to Helen Grainger before her death continued at yesterday’s coronial inquest.
Head of Cardiothoracic Anaesthesia and Perfusion at Sydney’s Royal Prince Alfred Hospital, Dr Paul Forrest, told the inquest Mrs Grainger suffered a severe anaphylactic reaction and intravenously injecting adrenaline was the “reasonable” course of action.
Mrs Grainger suffered a reaction to the antibiotic Keflin minutes after undergoing an advised pregnancy termination at the Lambton Road Day Surgery in 2007.
Her sedationist, Dr Adrian Wenck, told the court he injected five small doses of adrenaline.
On day one of the inquest Director of the Allergy Unit at Royal Prince Alfred Hospital, Dr Robert Loblay said the amount was too much and should have been injected muscularly.
“I disagree,” Dr Forrest said.
“You have to be guided by the patient’s response . . . a small bolus dose was reasonable in this circumstance.”
He said intravenous injections in hospitalised patients suffering anaphylaxis were easily monitored, but he pointed out Mrs Grainger was not hooked up to an ECG and her blood pressure and heart rate were not regularly recorded.
Dr Forrest said if an overdose of adrenaline was administered Mrs Grainger’s pulse would have been
“well over 100” three minutes after the injection, not in the mid 70s as it was recorded.
Dr Wenck told Deputy State Coroner Scott Mitchell, Mrs Grainger had not been hooked up to an ECG as she was moving too much and gasping for air.
Dr Forrest said more aggressive attempts, and possibly a tracheotomy, should have been attempted to allow Mrs Grainger to breathe as her airways quickly swelled from the reaction.
The Raymond Terrace Coroner’s Court heard that Dr Wenck was unable to insert a tube into the 29-year-old’s throat and continued pumping oxygen via a bag through the mouth.
The third expert witness, Associate Professor at the University of Sydney, Dr David Barnes agreed a muscle relaxant would have aided in intubating Mrs Grainger.
He recommended regular emergency life support training for any practitioners completing sedation procedures.
The inquest resumes on Monday when final submissions will be made to the coroner.