Savita’s final hours set out by ICU nurse

The final hours of Savita Halappanavar’s life were recounted at her inquest yesterday by the intensive care nurse who cared for her.

Jacinta Gately said when she came on duty at 8pm on Saturday, October 27th, Ms Halappanavar’s “non-invasive blood pressure was unrecordable”, her heart rate was 150-55 beats per minute (bpm), she was intubated, ventilated and sedated with morphine.

On admission on Sunday, October 21st, her heart rate had been about 85 bpm.

“I was made aware that Ms Halappanavar’s husband Mr Halappanavar was in the waiting room with friends and was anxious to see his wife,” said Ms Gately.

At about 9pm an arterial line was inserted and Ms Halappanavar’s heart rate occasionally dropped from its constant 150bpm to 90bpm, she said. Her blood pressure was very low.

“Adrenaline and noradrenalin infusions were increased until her blood pressure improved.” Tests found her blood lactate levels were now “very high” at 24, up from eight on Thursday morning and grossly exceeding desirable levels of 1.5. The inquest heard earlier high lactate levels were an indicator of sepsis and anything above four was an indicator of sepsis.

"Ms Halappanavar was unresponsive during this time, her pupils were very sluggish, size 4-5 and there was no response to stimuli." Her body was also very swollen.

Abdomen distended
"She was very oedematous, fingers flexed tightly, feet extended and very stiff. Her abdomen was very distended," said Ms Gately. There was also heavy vaginal bleeding, she added.

“I went to the waiting room to meet Ms Halappanavar’s husband Praveen at some time between 21.30 and 22.00. I apologised for keeping him and his friends waiting. I explained what we had been doing and brought him and some friends in to see Ms Halappanavar. They stayed a little while with Ms Halappanavar and left again. Dialysis had started by this time.”

At about 10pm, she said, alarms on the ventilator began ringing. Ms Halappanavar was given an intravenous infusion of cistatracurium, a drug to relax her skeletal muscles in an effort to help her breathe.

At 11pm, Ms Halappanavar “remained unresponsive”. A system to monitor her level of consciousness found her at between one and four, when ‘awake’ levels would be 100. Her blood pressure remained very low, while her lactate levels were continuing to rise.

At 11.45 pm, sodium bicarbonate, dextrose and insulin were infused in an effort to treat rising potassium levels and her abnormal heart rhythms.

"Mrs Halappanavar's husband and friends had been coming in and out for a few minutes. Each time I kept them informed of Mrs Halappanavar's critical condition," said Ms Gately. "At 12 midnight approximately she was washed and blood-stained pads renewed." She said whenever they turned Ms Halappanavar, her heart-rate increased from 140bpm to 190bpm. "So we stopped and let her heart settle."

Heart rate chaotic
Between 12.30am and 12.45am, she and two colleagues were sitting by Ms Halappanavar's bed. The monitor showed her heart rate becoming chaotic, with a "broad spectrum rhythm".

"Pulses were checked. None were palpable. CPR commenced by Dr Aoife Quinn, staff nurses Veronica Rafftery, Therese Connolly, Jeurgen Schone, Áine Nic an Bheath and myself," she said. "Within minutes of commencing CPR I went out to find Mr Halappanavar to let him know what was happening, that his wife's heart had stopped and that we had started CPR."

During her evidence, Mr Halappanavar, who was sitting alone at the back of the court, bowed his head, his eyes closed and with one hand gently rubbing his forehead. Ms Gately asked for a glass of water before continuing.

“I asked him if he wanted to be present while this was going on and he replied that he did. I explained that it would be very difficult for him. A friend accompanied him for support,” Ms Gately said.

“CPR continued until after 1.15 when a decision was made to cease compressions as Ms Halappanavar was not responding to our efforts. “Dr Quinn informed Mr Halappanavar that his wife was unresponsive and that she had passed away. Time of death recorded at 01.09 hours.”