06-28-2017, 02:18 AM
A 78-year-old man who lives alone is brought to the emergency department by ambulance because of respiratory distress. According to the brief history obtained by the paramedics, he is having abdominal pain since the morning and reports a history of congestive heart failure, insulin dependent diabetes mellitus, hypertension, and peripheral vascular disease. On arrival to the hospital, he is very drowsy and his temperature is 36.7 C (98.0 F), pulse is 110/min and irregular, blood pressure is 90/54 mm Hg, respirations are 24/min, and oxygen saturation is 84%. He appears to be in great distress from his abdominal pain. Laboratory studies show:
Pa O 2 56
Pa CO 2 54
Ph 7.35
After starting an intravenous catheter and administering a diuretic, you are getting ready to intubate the patient. The emergency department nurse conveys a message from the patient's daughter in Florida that there is a living will written by the patient which mandates that under no circumstances should he be intubated, resuscitated by CPR or dependent on artificial ventilation or feeding. The nurse reports that the daughter was very emotional and adamant that the patient should just be made comfortable, and that she would sue if he was intubated or if CPR carried out. During that emotional conversation she forgot to leave her phone number. The most appropriate next step in management is to
A. Call a hospital administrator to make a decision
B. Call a hospital lawyer for advice
C. Intubate the patient
D. Respect the daughter's wishes and keep the patient comfortable without intubation
Pa O 2 56
Pa CO 2 54
Ph 7.35
After starting an intravenous catheter and administering a diuretic, you are getting ready to intubate the patient. The emergency department nurse conveys a message from the patient's daughter in Florida that there is a living will written by the patient which mandates that under no circumstances should he be intubated, resuscitated by CPR or dependent on artificial ventilation or feeding. The nurse reports that the daughter was very emotional and adamant that the patient should just be made comfortable, and that she would sue if he was intubated or if CPR carried out. During that emotional conversation she forgot to leave her phone number. The most appropriate next step in management is to
A. Call a hospital administrator to make a decision
B. Call a hospital lawyer for advice
C. Intubate the patient
D. Respect the daughter's wishes and keep the patient comfortable without intubation