Emergency medicine can be a tough field. We don't have pre-existing relationships with most of our patients, nor do we have time to discuss the intricacies of their wishes when things are going poorly. Last night with very little warning a patient rolled in from a nursing home who was profoundly bradycardic (HR 7 - 10) with a BP in the 50s. Due to inadequate respirations the patient had a combitube (which is a supraglottic airway) placed by EMS through which the patient was receiving assisted respiration This paperwork accompanied the patient. What would you do?
This case demonstrates to me the need for physicians and families to have candid discussions with each other regarding end of life care. To me it seems medically futile to perform chest compressions without giving drugs and without establishing an airway. I think part of our duty as physicians and healthcare providers is to have these difficult conversations and help guide people to make the right (and medically appropriate) decisions for their loved ones.
Steph, I agree 100%. Families MUST have these conversations. I think folks don't really understand the questions, and are afraid to ask.
ReplyDeletePlus a lot of people want "everything done". But some are afraid of being on a respirator. I didn't realize until going through medical school that the airway usually comes before needing CPR so being on a vent was preferable to prevent having someone pounding on your chest.
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