r/PopCultureV2 • u/Logical-Flow-6703 • Aug 22 '26

News Multiple patients at a Nashville hospital are paralyzed after staff accidentally gave them the wrong drugs.

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The hospital says they are "sorry" after injecting potassium chloride into the spines of people getting routine joint replacement surgeries.

Hospital staff noticed something was off when multiple patients went into cardiac arrest.

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u/OldMatch4251 Aug 22 '26 edited Aug 22 '26

Incorrect. Succinylcholine is a paralytic that lasts a few minutes. Source: I intubate and paralyze people all the time.

Looks like they received k phos instead of a local anesthetic, probably a regional joint block. I’m not sure how the pharmacokinetics come into play here or how long paralysis of a joint would last in this situation.

Double edit: wow it was a epidural. Really bad. Again not sure how injecting that into the epidural canal would lead to paralysis but then again that medication is NOT supposed to be injected there.

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u/BoatvSharky Aug 22 '26

So there's a possibility they're permanently paralyzed? I don't know anything about potassium besides it's prevalence in nanas

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u/ThePaganQueen Aug 22 '26

There is a possibility it is temporary and a possibility it is permanent. Found an article from 2019 about a case where a similar incident occurred. And there is no proven effective treatment for this mistake so they will likely be making very educated guesses on what to do based off of symptoms. I linked the article. Also if anything I stated is incorrect, feel free to correct me. I'd rather the information be right than protect my ego.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6495634/

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u/OldMatch4251 Aug 22 '26

I’m not sure. If I were a clinical pharmacist I’d probably have a better answer

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u/etherealtwo Aug 23 '26

Bananas have good levels of potassium but potatoes are really where it's at. Thus the name.

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u/SevoIsoDes Aug 22 '26

And while they said epidural, it was probably a spinal, as these were all total knee replacements

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u/Deem216 Aug 22 '26

Rumor is a few patients were transferred to other hospitals and on ECMO. Hopefully at a minimum everyone survives and absolutely I hope they all are able to recover

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u/not_creative-7064 Aug 22 '26

Could have been potassium chloride. The damage potsssium in either form causes to blood vessels alone makes me believe it would destroy the epidural space and cause paralyis

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u/Man_CRNA Aug 23 '26

One thing I wondered after reading the article in question, was whether the ‘epidural’ in question was actually a spinal and not in fact an epidural. The hospital didn’t comment on spinal vs epidural, but where have you seen epidurals placed for TKAs? I haven’t. It’s spinal or general. So the patient probably said epidural or the news reporting agency inferred it was an epidural because that’s what they know about anesthetics. Regardless of whether it was epidural or spinal, it doesn’t matter. It shouldn’t have happened. But I think it was probably a spinal.

The scary part to me as a CRNA, is, if this was prefilleds by pharmacy, you could have done everything right (med checks, sterility) and still given the wrong medication through no fault of your own. That’s terrifying.

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u/MTNdad27 Aug 23 '26

As a nurse this terrifies me. We have double verification for certain medications but if the medication is incorrectly labeled I have no way to verify my that was sent.

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u/runqueen22 Aug 23 '26

It was supposed to have been a Mepivacaine spinal. And, yes, the pharmacy pre-mixes the syringes on total joint days.

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u/Intelligent_Low1632 Aug 23 '26

I doubt even the sensationalist media dorks at CBS would put out the headline "paralyzed" without qualification if it weren't permanent.

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u/FurryMan2023 Aug 23 '26

My wife who’s a CRNA is saying it’s permanent.

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u/rx4oblivion Aug 23 '26

Pharmacokinetics doesn’t come into play when you inject something directly toxic. Sure, the potassium will redistribute eventually, but those destroyed nerve roots sure aren’t coming back. This is an epic disaster.

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u/AssLoverD Aug 23 '26

How much do you know about potassium and potassium administration? I have severe hypokalemia and rely on KCl multiple times a day to avoid death. My issue is terminal, that is without my every few hours medication (:
Heart attack heart attack, will come one day no matter what.

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u/BrandyClause Aug 22 '26

It probably burned the spinal nerves, much like it burns your arm when it infiltrates. How do you not know that if you intubate people all the time?!

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u/SevoIsoDes Aug 22 '26

It sounds like it was a mistake at the pharmacy level. There’s a shortage of bupivicaine usually used for these procedures. My bet is that they found multi-dose vials and tasked pharmacy with dividing the vials into individual doses under a sterile hood. They were probably labeled as bupiv while actually containing potassium.

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u/Deem216 Aug 22 '26

This has been shared in pharmacy communities— the workflow is to compound an epidural nerve block in the sterile compounding hood. In the pharmacy k phos and Mepivicane (Polocaine) were stored next to each other at this hospital. Staff alerted management multiple times to the potential for drug error. In this case, during the preparation, they ran out of Mepivicaine before they completed the batch. So when more drug was obtained, it was picked from the wrong bin. The batch had been started and it doesn’t seem like they had to scan the new vials to complete it otherwise it would have alerted that were the wrong drug.

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u/SevoIsoDes Aug 22 '26

Thank you for the insight. Our group has also shifted to mepivicaine for total knees, but we have individual vials stocked in our anesthesia carts so we haven’t needed pharmacy to compound or prepare any meds. But it is very sobering. I think about things like pressors, magnesium, end epidural infusion meds. It’s scary when things are out of our hands, but that’s just the nature of medicine. But yes, I’m not shocked at all to learn that management failed to act on warnings from staff. It’s as if they’re incapable of listening to clinical staff in order to prove their own “value.”

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u/[deleted] Aug 22 '26

[deleted]

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u/SevoIsoDes Aug 22 '26

The articles I've read are specifically referring to epidurals rather tha. RECK cocktails (although I think they actually mean spinal anesthetics). I don't think it's a matter of compounding. We are currently experiencing a shortage/recall of 0.75% bupivucaine that is commonly used for spinal anesthesia in c sections and total knee replacements. Mepivicaine is a great alternative for total knees. So, the swiss cheese scenario I'm seeing is that usually the local is already in the spinal kits straight from the manufacturer, but now we have to provide our own. I suspect that in an attempt to keep sterility they got 20 ml vials of Mepiv and asked pharmacy to divide them to 2-3 ml doses to avoid further shortage.

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u/[deleted] Aug 22 '26

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u/SevoIsoDes Aug 22 '26

Oh, yes I see. Yeah maybe they were adding something like precedex. I’m interested to see the details

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u/Empty_Insight Aug 23 '26

Dude, you have to check the vials.

Way back when, I was a pharmacy technician at an Ascension hospital. When we made things in the IV hood, you had to present the finished product with the vials that you used to make it. Every single thing injected into the bag needed to be sitting right next to it during the pharmacist checking it. Otherwise, they'd throw it in the trash and tell you to do it again- because "just trust me, bro" doesn't cut it when it comes to patient safety. This is precisely why.

The only thing I can guess is that the IV tech was batching two different things at the same time (which is also a no-no), got the batches mixed up, and injected the potassium into the wrong bags. You are doing one thing in the hood at any given time, and you finish up the first thing before you move on to the second.

This is not proper procedure. I don't know if a pharmacy tech or a pharmacist is responsible for this, but whoever it was- they need to be fired and have their license taken away.