verypositive...pl answer - midwest

[ArchivalUser]

A 54-year-old African American woman has been in the intensive care unit (ICU) for the past 10 hours because she has failed to regain consciousness after passing out at a restaurant 11 hours ago. Upon initial arrival at the emergency department the patient's friend stated that the patient had remarked about the sudden onset of a terrible headache and neck stiffness while they were having lunch. A few minutes after the onset of the headache, she became confused, vomited, and lost consciousness. She regained consciousness briefly en route to the hospital, but she has been unconscious since admission. On arrival she was intubated and mechanically ventilated and transferred to the ICU, where intravenous fluids were started. Vital signs are: pulse 110/min and blood pressure 174/96 mm Hg. She exhibits no spontaneous movement and is unresponsive to verbal or painful stimuli. Lung fields are clear to auscultation. CT angiogram confirms subarachnoid hemorrhage from a ruptured cerebral aneurysm and impaired intracranial circulation. The family should be counseled regarding which of the following?
A) The futility of continued life support
B) The need for screening of first-degree relatives for aneurysms
C) The need for them to sustain hope
D) The need to have a guardian ad litem appointed to make informed decisions about the patient's care
E) The probability that the patient will not regain consciousness
but difference is the question nimi posted mentioned "all measures fail", so I think should be A before we stop any further effort. like Fisher ethetic #1

you answered ..AA A

I think it should be D...because you have to dicide how to go from here..to tertiary care or no or just same hospital..for that you need some one from family to come forward as an guadian

[ArchivalUser]

DD

[ArchivalUser]

i agree,if pt is unable to take decision we need substitute for him first ,even if u want to discuss fytile care u need someone as substituted judjment for pt

[ArchivalUser]

thank you for this discussion

if patient is brain dead, we can stop all measurment, but nice to talk to the family, doesn't matter who is the one speaking in the family, if they are disagree, always can bring to the committee. that's why we often see "family disagree", but we don't ask them to point someone to speak for the patient first.

Patient is the first. but I don't know it is true or not in the real world, we ask the family to point someone to speak for the patient? to my understanding, not patient's family decide shall we continue or not. doctor decide based on patient's situation

[ArchivalUser]

hei,

correct me if wrong. also another NBME questions, kid in ICU


You have been treating a 5-month-old child in the neonatal intensive care unit (NICU). He was delivered at 26 weeks' gestation by cesarean delivery because of premature rupture of membranes. The mother is 18 years old and is unemployed. There are two other children in the home. The father is not living with them, and he has not been in contact with the mother. The mother rarely visits the NICU. The infant had severe respiratory distress syndrome at birth and required dopamine for blood pressure support. His condition progressed to pulmonary interstitial emphysema and bronchopulmonary dysplasia by 4 weeks of age. At 4 months of age he required a tracheostomy and medication for control of his blood pressure. Now, at 5 months of age, the boy has a cardiac arrest requiring resuscitation and placement of chest tubes. He then develops seizures that are eventually controlled with medication. The neonatologist feels that the child will always require life support. The mother refuses to discuss the possibility of withdrawing life support. Her insurance is Medicaid. The hospital bill for this child is now $350,000.

Item 1 of 2

12. To guide further treatment at this time, it is most important to assess which of the following?

A) The extent of neurologic injury
B) The financial impact on the family
C) The mother's level of understanding of the child's prognosis
D) Whether another family member is better suited to make decisions about the patient's care
E) Your state's law regarding futile care

Item 2 of 2

13. One week later the mother and the attending physician are unable to reach an agreement on the management plan. Which of the following is the most appropriate next step?

A) Ask the court to appoint a guardian
B) Defer major decisions until the father can be located
C) Have the social worker contact Medicaid regarding further coverage]
D) Involve the hospital bioethics committee
E) Maintain the patient on a respirator but transfer him out of the NICU

[ArchivalUser]

c
d
??

[ArchivalUser]

a
dd

[ArchivalUser]

I chose a and d.

the 54 yo one. "continued life support" makes me hesitate to choose a, she is not dead, she still has breath. but I really don't know d would be the best answer.

[ArchivalUser]

nimi, is 2 your another ethtic questions answer? point a guardian?

[ArchivalUser]

CC
DD