11-30-2015, 06:17 AM
Two days after admission to the hospital for treatment of pneumonia, an 80-year-old Mexican American woman with metastatic small cell carcinoma of the lungs develops swelling of the lips and difficulty breathing 2 minutes after receiving a dose of levofloxacin. Vital signs now are temperature 37.0°C (98.6°F), pulse 120/min, respirations 28/min, and blood pressure 100/60 mm Hg. Pulse oximetry shows an oxygen saturation of 82% while the patient breathes 100% oxygen by nonrebreather mask. The patient is cachectic and in acute respiratory distress. On physical examination, auscultation of the lungs discloses inspiratory and expiratory wheezes with audible stridor. There is a diffuse urticarial rash over the patient's trunk and extremities. Glasgow Coma Scale score is 15. The patient's chart shows that she has signed a Do Not Resuscitate (DNR) form indicating that she wishes no cardiopulmonary resuscitation, cardioversion, or intubation. The patient's son is listed as having power of attorney. You ask the patient, "Do you want me to intubate you to help you breathe?" She looks you in the eye and nods, "Yes." Just as you begin the intubation, the patient's son enters the room and says, "What are you doing? Don't you dare intubate my mother!" Which of the following is the most appropriate next step?
A) Activate comfort measures only B) Administer epinephrine only C) Call the hospital administrator D) Have security remove the son from the room E) Intubate the patient
A) Activate comfort measures only B) Administer epinephrine only C) Call the hospital administrator D) Have security remove the son from the room E) Intubate the patient