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Old 11-15-2007, 11:01 AM
 
3,124 posts, read 4,246,625 times
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This came up in my ethics class:

You have a patient on the board who has advanced HIV disease. The patient was brought in by a neighbor with mulitple GSW. The patient asks you NOT to transfuse then loses consiousness.

What do you do?


(btw..hi..)
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Old 11-15-2007, 12:53 PM
 
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Quote:
Originally Posted by victorytampa View Post
This came up in my ethics class:

You have a patient on the board who has advanced HIV disease. The patient was brought in by a neighbor with mulitple GSW. The patient asks you NOT to transfuse then loses consiousness.

What do you do?


(btw..hi..)

I'd call 911..
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Old 11-15-2007, 12:57 PM
 
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Unfortunatly, in today's world, if the patient has relatives, and you don't do everything you can to prolong his life, you may be facing a malpractice charge.

From an ethical standpoint, if the patient makes the request, I think the doctor needs to honor the request. If someone else makes the request, and he doesn't know how the patient feels, then he has to do everything he can to help.
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Old 11-15-2007, 01:05 PM
 
Location: Pikeville, Ky.
13,577 posts, read 21,738,535 times
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Quote:
Originally Posted by victorytampa View Post
This came up in my ethics class:

You have a patient on the board who has advanced HIV disease. The patient was brought in by a neighbor with mulitple GSW. The patient asks you NOT to transfuse then loses consiousness.

What do you do?


(btw..hi..)
If he has multiple gunshot wounds I would have to stop the bleeding, position for shock and call 911..And let others worry about the patients request not to have a transfusion, since I couldn't do it anyway...
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Old 11-15-2007, 02:06 PM
 
3,124 posts, read 4,246,625 times
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To clarify, the question is directed as if you were a Physician or Pysician Assistant (what my studies are for).

We're going to discuss it next Tuesday and I thought it would be interesting to get some other people's opinions.

According to what I've read so far, I interpret that you transfuse the patient and attempt to contact family to investigate a DNR Order (Do Not Rescusitate). However, in a clinical setting (as I was surprised to learn) there's a lot of leeway for what the assigned Dr. or PA can do. It's not black and white.
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Old 11-15-2007, 02:20 PM
 
Location: Between Here and There
3,684 posts, read 11,005,122 times
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Quote:
Originally Posted by victorytampa View Post
To clarify, the question is directed as if you were a Physician or Pysician Assistant (what my studies are for).

We're going to discuss it next Tuesday and I thought it would be interesting to get some other people's opinions.

According to what I've read so far, I interpret that you transfuse the patient and attempt to contact family to investigate a DNR Order (Do Not Rescusitate). However, in a clinical setting (as I was surprised to learn) there's a lot of leeway for what the assigned Dr. or PA can do. It's not black and white.
This is why having advanced directives before such a situation occurs is important. Even though the patient said not to tranfuse him, he was in shock and can not be held at his word in that situation (same as if he were intoxicated, drugged, sedated, etc.), he didn't sign anything so you have to transfuse him, and do anything else you can, because if he dies and you didn't then you get sued. If during the course of treating him his next of kin shows up and signs a DNR, you still have to do everything to save his life except resusitate him if he codes...so you would still transfuse him because that has nothing to do with not resusitating him, that would be not treating him. If however the next of kin shows up and says they are, for some reason, against transfusions then they can sign to decline them and you would stop any blood product infusion that was already in progress. This is assuming that the guy still hasn't woken up to give his own opinion. Good luck on the class.
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Old 11-15-2007, 02:24 PM
 
3,124 posts, read 4,246,625 times
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Originally Posted by irishmom View Post
This is why having advanced directives before such a situation occurs is important. Even though the patient said not to tranfuse him, he was in shock and can not be held at his word in that situation (same as if he were intoxicated, drugged, sedated, etc.), he didn't sign anything so you have to transfuse him, and do anything else you can, because if he dies and you didn't then you get sued. If during the course of treating him his next of kin shows up and signs a DNR, you still have to do everything to save his life except resusitate him if he codes...so you would still transfuse him because that has nothing to do with not resusitating him, that would be not treating him. If however the next of kin shows up and says they are, for some reason, against transfusions then they can sign to decline them and you would stop any blood product infusion that was already in progress. This is assuming that the guy still hasn't woken up to give his own opinion. Good luck on the class.

I think you have my text book
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Old 11-15-2007, 02:26 PM
 
1,932 posts, read 4,340,688 times
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Quote:
Originally Posted by victorytampa View Post
This came up in my ethics class:

You have a patient on the board who has advanced HIV disease. The patient was brought in by a neighbor with mulitple GSW. The patient asks you NOT to transfuse then loses consiousness.

What do you do?

(btw..hi..)
Quote:
Originally Posted by victorytampa View Post
To clarify, the question is directed as if you were a Physician or Pysician Assistant (what my studies are for).

We're going to discuss it next Tuesday and I thought it would be interesting to get some other people's opinions.

According to what I've read so far, I interpret that you transfuse the patient and attempt to contact family to investigate a DNR Order (Do Not Rescusitate). However, in a clinical setting (as I was surprised to learn) there's a lot of leeway for what the assigned Dr. or PA can do. It's not black and white.
Well, given the parameters you've set forth... I'd work on the patient as much as possible without a transfusion while directing someone to attempt to contact family or research a DNR. However, if it came to crunch time and the patient definately needed a transfusion to continue living, I would give the transfusion and work out the details later (if the patient survives).

You're not sure if the patient is in the right frame of mind when making the "no transfusion" statement, so I would err on the side of caution and give a transfusion only if absolutely necessary. That's me, personally.

However, based on the patient's statement, it would not be unreasonable or unethical to refuse to transfuse, as long as a second person heard the patient's wishes, while working on the patient to the best of your ability.
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Old 11-15-2007, 02:31 PM
 
Location: Between Here and There
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Quote:
Originally Posted by victorytampa View Post
I think you have my text book
That and some crazy ER experiences.
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Old 11-15-2007, 03:05 PM
 
Location: land of quail, bunnies, and red tail hawks
1,513 posts, read 3,088,962 times
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Well, according to my Emergency Trauma Technician training, once a person loses consciousness he is no longer able to decline treatment and the medical professional is required to do whatever is necessary to prolong life UNLESS, as Irishmom stated, there is an official written directive that has been produced stating otherwise.
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