Iatrogenic complications Medical errors can fall into various categories listed below: •
Medication: Medication medical errors include wrong prescription, impaired delivery, or improper adherence. The process of prescribing medication is a complex process that relies on the accurate transfer of information through various parties. Prevention methods include increased use of electronic prescription, pre-packaging unit dosing, and ensuring medical literacy among patients. •
Surgical: Surgery-related medical errors can be anesthesia-related, but most often include wrong-site and wrong-patient procedural errors. Preventive measures include following and double-checking standardized surgical protocol before, during, and after procedures. Universal surgical protocols include verification of patient identity and proper site-marking. •
Diagnostic: Diagnostic errors include misdiagnosis, wrong diagnosis, and over diagnosis. Diagnostic errors are often the result of patient characteristics and physician bias. • Machine interface: Errors in this category refer to mistakes in human interaction with tools or machines. Machine-related errors can be reduced by standardization and clear differentiation in design of products. • Transition and handoff: Errors in this category can occur person-to-person or site-to-site during transfer, and can be managed by adhering to proper hand-off protocols. • Human factors, teamwork, and communication: Errors in this category highlight the impact of culture and relationships on communication. These concepts can play a role in other categories of medical errors. Preventive measures include cultivating a "culture of safety" which includes creating an environment where people feel comfortable discussing concerns, feedback, and errors without fear of punishment. •
Healthcare-associated infections (HAIs): HAIs are complications of general treatments involving
microorganisms or viral infections and are most commonly caused by indwelling devices (
urinary catheters,
central lines) or previous surgical procedures. Common microbes involved in HAIs are
Escherichia coli,
Proteus mirabilis, and
Clostridioides difficile.
Cardiovascular complications Atrial fibrillation Atrial fibrillation is a type of
arrhythmia characterized by rapid and irregular heart rhythms due to irregular atrial activation by the
atrioventricular (AV) node. In the pathogenesis of atrial fibrillation, there is no effective pumping of blood into either the
pulmonary or
systemic circulation from the left
ventricle of the heart. The left and right ventricles (lower chambers of the heart) do not fill properly due to the irregular contraction of the left and right
atria (upper chambers of the heart). The heart does not effectively pump blood into the pulmonary or systemic vasculature, and causes the blood to remain within the chambers of the heart. The collection of blood within the heart due to atrial fibrillation can cause and increase the risk of development of a
thrombus (blood clot). (inflammation of the
veins),
endocarditis and
artificial heart valves.
Metabolic complications Diabetes mellitus Diabetes mellitus, also known simply as diabetes, is a disorder of the regulation of
blood glucose (a common type of sugar) levels. There are two types of chronic diabetes mellitus: type I and type II. Both lead to abnormally high levels of blood glucose as the body is not able to properly absorb the sugar into tissues. Diabetes requires a life-long consistent monitoring of food intake, blood sugar levels, and physical activity.
Diabetes mellitus may present a series of complications in an advanced or more severe stage, such as: •
Cardiovascular disease. Adults with diabetes are significantly more likely to die from heart disease than are those without diabetes. Diabetes is associated with risk factors for various cardiovascular diseases including obesity, insulin resistance, high blood cholesterol and triglyceride content, and high blood pressure. These conditions increase risk of
thrombosis,
atherosclerosis (blockage of coronary arteries leading to inadequate supply of oxygen to parts of the heart), and hypertension Initial symptoms may present as numbness, tingling, pain, muscular weakness, loss of reflexes or proper bodily functions, and many others. Diabetic nephropathy is specifically characterized by abnormally high levels of urinary
albumin excretion. This affects approximately 40% of patients with type I or type II diabetes. •
Diabetic retinopathy. Chronic or prolonged type I and type II diabetes can lead to damage in the blood vessels of the retina due to
hyperglycemia (excessive blood glucose). Damage and blockage of the vessels causes
microaneurysms, tears, and leakage of fluid into the back of the eye. This can eventually lead to abnormal blood vessel growth, nerve damage, or excessive pressure buildup in the eye. Symptoms initially present as blurred vision but can lead to more serious complications such as
blindness,
glaucoma,
retinal detachment, and
vitreous hemorrhage. • Foot damage. Diabetes mellitus can lead to poor vascular blood flow to the extremities. Injury of the foot with inadequate blood flow can progress to
ulcers and become infected. Individuals with
diabetic neuropathy may not notice the damage and may develop
gangrene (tissue necrosis due to inadequate blood supply). • Skin conditions. Insulin insensitivity in the case of type II diabetes can cause prolonged increases in blood insulin. Insulin normally binds to insulin receptors but in excess amounts may bind to
insulin-like growth factor (IGF) receptors in epithelial tissue. This can cause excessive proliferation of keratinocytes and fibroblasts. This presents as
acanthosis nigricans, a thickening and darkening of areas of the skin such as the armpits, necks, hands, and face. Other skin conditions include
diabetic dermopathy, digital sclerosis, eruptive xanthomatosis, and others.
Neurologic / psychiatric complications • Hepatic encephalopathy is a possible complication of liver
cirrhosis. • Significant intellectual, physical, and developmental disability are common complications of untreated
hydrocephalus. •
Suicide is a common complication of many disorders and conditions that consistently affect a person's life negatively, such as
major depressive disorder,
posttraumatic stress disorder,
schizophrenia,
anxiety disorders, or
substance abuse. • Complications of outpatient drugs are very common and many patients experience worry or discomfort due to them. •
Paradoxical reaction to a drug; that is, a reaction that is the opposite to the intended purpose of the drug. An example is
benzodiazepines, a class of psychoactive drugs considered minor
tranquilizers with varying hypnotic, sedative,
anxiolytic,
anticonvulsant, and muscle relaxant effects; paradoxically they may also create hyperactivity, anxiety, convulsions etc. in susceptible individuals.
Reproductive complications Pregnancy Pregnancy is the development of an embryo or
fetus inside the womb of a female for the rough duration of 9 months or 40 weeks from the last menstrual period until birth. It is divided into three trimesters, each lasting for about 3 months. The first trimester is when the developing embryo becomes a fetus, organs start to develop, limbs grow, and facial features appear. The 2nd and 3rd trimesters are marked by a significant amount of growth and functional development of the body. •
Hypertension. The developing fetus enlarges in the mother's womb, placing pressure on the arteries and vasculature of the mother. This causes a reduction in blood flow and a systemic increase in blood pressure. If the mother had high blood pressure prior to and after pregnancy it is considered
chronic hypertension; if it occurs after 20 weeks of
gestation or pregnancy, it is
gestational hypertension. A previously hypertensive mother who shows signs of gestational hypertension can lead to
preeclampsia, a more severe case which can be detrimental to the mother and developing fetus. •
Gestational diabetes. Appropriate levels of blood sugar is typically maintained by
insulin secretion from the
pancreas. During pregnancy the
placenta surrounding the developing fetus produces hormones that can inhibit the action of insulin, preventing the mother's blood sugar from decreasing. Occurs primarily in the second half of pregnancy and can cause excessive birth weight, preterm delivery, and place the child at greater risk for type II diabetes. •
Preterm labor. Delivery of the baby prior to 37 weeks of pregnancy is considered preterm. This can cause a variety of issues with the child including underdeveloped viscera (organs), behavioral or learning disabilities, low birth weight, and respiratory issues. •
Miscarriage. The loss of the developing fetus prior to 20 weeks of pregnancy. •
Stillbirth. The loss of the developing fetus after 20 weeks of pregnancy. Can be due to a variety of reasons including chromosomal abnormalities, developmental issues, or health-related problems of the mother. Persistent, acute nausea throughout pregnancy that does not go away after the first trimester. Different from morning sickness which is more common and less severe.
Respiratory complications Streptococcal pharyngitis Streptococcal pharyngitis, also known as strep throat, is an infection of the respiratory tract caused by
group A Strep,
Streptococcus pyogenes, a gram-positive, cocci,
beta-hemolytic (lyses blood cells) bacteria. It is primarily spread by direct contact and the transfer of fluids via oral or other secretions and manifests largely in children. Streptococcal pharyngitis can lead to various complications and recurrent infection can increase the likelihood. In many of these, lack of treatment and the body's
immune response is responsible for the additional adverse reactions. These include: In addition to the symptoms of strep throat, individuals may experience increased a red rash, increased red tone, and strawberry tongue. Treatment is the same as for strep throat. •
Rheumatic fever. Rheumatic fever generally develops a few weeks after symptoms of strep throat have passed and is less likely to develop if prompt treatment (antibiotics) is given. •
Glomerulonephritis. Onset of kidney damage that may present a few weeks after strep infection. Rather than being a direct result of infection in the kidneys, It is believed to be caused by an overreactive immune response. Symptoms can include blood or protein in the urine, hypertension, and reduced urine output. Can lead to further kidney damage later in life •
Otitis media. Infection of the middle ear. •
Meningitis. Infection of the meninges of the central nervous system (brain and spinal cord) that leads to swelling. Symptoms vary and differ between adults and children but can include headaches, fever, stiff neck, and other neurological-related issues. Early treatment is important to prevent more serious complications. •
Toxic shock syndrome. A severe reaction of the body to toxins produced by various bacteria such as Streptococcus pyogenes. Results from an overactive response by the immune system and can cause hypotension, fever, and in more severe cases, organ failure.
Surgical / procedural complications •
Puerperal fever was a common complication of
childbirth, contributing to the high mortality of mothers before the advent of
antisepsis and
antibiotics. •
Erectile dysfunction and
urinary incontinence which may follow
prostatectomy. • Malignant hyperthermia can be a reaction to general
anesthetics, as a complication in a surgery. • Fractured
ribs and
sternum may be a complication of
cardiopulmonary resuscitation attempts.
Other examples of complications •
Sepsis (infection of the blood) may occur as a complication of a bacterial, viral, or fungal infection. •
Miscarriage is the most common complication of early
pregnancy. •
Eczema vaccinatum is a rare and severe complication of
smallpox vaccination in people with
eczema. == See also ==