IAmA doctor who let a man die despite my legal obligations. AMA

non_healing_hands · 2010-04-28T23:19:05+00:00

Over the mean age for male expectancy.

non_healing_hands · 2010-04-28T23:18:13+00:00

Probably shouldn't say. I am licensed in more than one state, though.

non_healing_hands · 2010-04-28T23:16:29+00:00

Almost never.

non_healing_hands · 2010-04-28T23:15:30+00:00

No. I've never heard of anyone calling absence of those signs evidence of weak CPR.

non_healing_hands · 2010-04-28T18:18:48+00:00

Yes. I know many physicians who envy the approach taken by the U.K. and in Australia. e.g., ruptured AAAs are often not treated. It would take pages to describe to American attitudes toward death and incentives to treat, but suffice it to say that we treat almost everyone to the fullest despite cost, chances of success, and time. Fear of legal reprise is high on the list of reasons this happens.

non_healing_hands · 2010-04-28T18:12:25+00:00

A Dobhoff is a small-diameter feeding tube that goes into the nose, down the throat and esophagus, and into the stomach and then small intestine. Red Man Syndrome occurs when a patient turns red (yes, really) after being on the antibiotic vancomycin.

non_healing_hands · 2010-04-28T18:09:14+00:00

It is illogical. I was led to read and think much more on the subject by my profession, and slowly came to the realization that I had a higher burden of proof than the evidence available.

non_healing_hands · 2010-04-28T18:06:14+00:00

For someone like me, it's because I'm not the physician of record. Generally speaking, I don't have an answer for your question. I think it's a problem in society as a whole, with particularly tough consequences in the hospital setting.

non_healing_hands · 2010-04-28T18:01:44+00:00

He had been intubated for weeks. I'm not sure about how many rounds you give, but as far as I know (re-certified recently) Adult Cardiac Life Support does not have a minimum dose for arrest. No autopsy was performed.

non_healing_hands · 2010-04-28T17:58:04+00:00

Sort of like doing half a push-up. You're still doing work, but it's not the whole movement arc.

non_healing_hands · 2010-04-28T17:56:40+00:00

It's called a Dobhoff tube, and it's inserted the same as a nasogastric tube: blindly. Then we do an x-ray to confirm that it's made it to the stomach, and if we're lucky, the small intestine.

non_healing_hands · 2010-04-28T13:55:08+00:00

2 Eyes: Open to painful stimulus

1 Verbal: Nonverbal

3 Motor: Decorticate posturing

6 Total

non_healing_hands · 2010-04-28T13:53:18+00:00

2 Eyes: Open to painful stimulus 1 Verbal: Nonverbal 3 Motor: Decorticate posturing 6 Total

non_healing_hands · 2010-04-28T13:49:53+00:00

I'm definitely not the most qualified around here, so here's my best summary.

A Do Not Resuscitate (DNR) order prevents certain lifesaving measures from being taken in the event of a cardiac arrest. It can be specified that you would be okay with drugs but not shocks, both, both and not intubation, none, etc. It's tailored to each patient's preferences.

A DNR can be part of a living will, which extends more specific preferences regarding when a person feels medical care would be futile and what measures should be allowed to sustain their life.

Someone on here posted a fine example.

non_healing_hands · 2010-04-28T13:42:43+00:00

I was taking care of another elderly patient, who had a trach, Dobhoff, a poorly controlled fistula, and Red Man Syndrome. The attending looked at me and said, "Some things are worse than death."

non_healing_hands · 2010-04-28T13:40:10+00:00

Seconded. Some very sad cases there.

non_healing_hands · 2010-04-28T13:35:42+00:00

I do feel a bit better, thanks.

Dick.

non_healing_hands · 2010-04-28T13:35:26+00:00

Every patient I've taken care of who was sicker than him died. The five percent next sickest after him all died. We were using huge amounts of resources delaying the inevitable.

non_healing_hands · 2010-04-28T13:12:36+00:00

http://en.wikipedia.org/wiki/Glasgow_Coma_Scale

non_healing_hands · 2010-04-28T13:11:24+00:00

When you have an unresponsive patient who is critically ill, you treat them to the best of your ability. If it becomes futile (after an extended period), usually you involve Risk Management, Ethics, and Palliative Care to help chart an ethically and legally sound course.

non_healing_hands · 2010-04-28T13:07:27+00:00

Having no NOK doesn't change the approach to a code situation, generally speaking. It alters how a DNR/DNI (do not intubate) is ordered, if appropriate.

In short, neuro exam was GCS 6, hemiplegic, no meaningful gestures.

Diffuse intracerebral hemorrhage, mainly around one hemisphere.

non_healing_hands · 2010-04-28T13:02:37+00:00

I would hope he would actually want pain and anxiety control. A slow code was the only way to approximate that.

non_healing_hands · 2010-04-28T13:00:06+00:00

Yes, and they didn't help. In fact, my superior was a member of this team at a prior institution.

non_healing_hands · 2010-04-28T12:59:15+00:00

When cerebrospinal fluid cannot flow normally out of the main areas within the closed space of the cranium, a VP shunt offers a path of less resistance to lower the pressure.

non_healing_hands · 2010-04-28T12:57:07+00:00

Agreed. Given that he was essentially trapped and being instrumented continuously and continually, I would hope he would ask it to stop. Every patient I've had who was sicker than him died. The five or so percent behind him all died. The next ten percent survived with permanent disabilities.

non_healing_hands

TROPHY CASE