Here’s the true story of a really unfortunate side effect from a very common medication. Remember that anyone can learn from their own mistakes, but a wise person learns from others’ mistakes.
A man was working onboard a cruise ship as a waiter when he developed flu-like symptoms. The physician on ship ordered promethazine (aka phenergan) 25mg IV.
A few hours later, the waiter’s right forearm became swollen and ecchymotic. Staff waited until the ship reached the next dock rather than evacuating him by helicopter. In the meantime, they massaged the affected area. This went on for approximately 24 hours. By the time he got to a hospital, he developed compartment syndrome and ultimately underwent amputation of his arm. He was awarded $3.34 million in damages.
Here’s what the plaintiff’s lawyer had to say:
“They gave (my client) the most dangerous type of medication they could give to treat this very simple, common problem that can be treated with a very light and easy medication — Zofran. It’s all they needed to do. (Dr.) gave the wrong medication, the wrong dosage by the wrong route through the wrong injection site, and it was administered over the wrong time and by the wrong method”
“ … [provider] missed the median cubital vein altogether and instead injected the drug into the ulnar artery in that forearm … Whereas intravenous administration of promethazine is merely improper and dangerous, shooting 25 milligrams of promethazine into an artery is never medically indicated, is extraordinarily reckless, and is nearly certain to cause catastrophic vascular damage.”
For some background: in 2009, the FDA began requiring manufacturers to add a boxed warning to promethazine’s labeling that highlights the risk of serious tissue injury if the drug is administered incorrectly. “Intravenous administration of promethazine can cause severe tissue injury, including gangrene, requiring fasciotomy, skin graft, and/or amputation” according to the FDA Web site. In addition, “Severe tissue injury can occur from perivascular extravasation, unintentional intra-arterial injection, and intraneuronal or perineuronal infiltration.”
This followed a lawsuit in which a musician was seen in the clinic for a headache. She received dilaudid and phenergan intravenously (which actually turned out to be intra-arterial) and suffered gangrene and amputation. She was awarded $700,000 in damages but later sued the manufacturer for not having a clear enough warning on the box and was awarded an additional $7 million.
