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A 45 year old cardiologist in the hospital with newly diagnosed advanced colon cancer is DNR. At 2am you are called to the bedside because she feels “weird.”
She tells you “This is my SVT.” Her pulse is 150. She asks, “Can I please have 6mg of adenosine IV?”
Do you:
She tells you “This is my SVT.” Her pulse is 150. She asks, “Can I please have 6mg of adenosine IV?”
Do you:
You perform the EKG. It is SVT. You give the adenosine. She goes into ventricular tachycardia. You say out loud, “Uh oh. V-tach.”
She is still conscious. She says, “Shock me you nitwit!”
Do you
She is still conscious. She says, “Shock me you nitwit!”
Do you
Because your mama didn’t raise no nitwit, you shock her. She returns to NSR.
After toweling off your sweat like Serena at Wimbledon, do you
After toweling off your sweat like Serena at Wimbledon, do you
As you start to discuss CODE status, she becomes irate. “I’m DNR! That shock was assault and battery! I’m going to sue AND leave a bad YELP review!!”
Just then she goes unconscious again. Monitor shows ventricular tachycardia. There are 30 people in the room staring at you.
Just then she goes unconscious again. Monitor shows ventricular tachycardia. There are 30 people in the room staring at you.
The 99 year old lady in the other bed, a retired nurse, beaks the silence by yelling, “Shock her you nitwit!”
In the heat of the moment in the absence of a better suggestion this sounds like a good idea so you defibrillate. You get the ROSC.
You ask for another towel.
In the heat of the moment in the absence of a better suggestion this sounds like a good idea so you defibrillate. You get the ROSC.
You ask for another towel.
RT is bagging the patient who is unconscious. She says, “Anesthesia is here. Would you like to intubate?”
What’s your answer?
What’s your answer?
Being clever, you say, “I need a minute to make this important decision.”
Just then the patient vomits and aspirates. RT says, “her sats are dropping.”
What now?
Just then the patient vomits and aspirates. RT says, “her sats are dropping.”
What now?
Did I mention you are a July 2 Medicine R2? Or as we say in the business, R1+1d.
Suddenly you hear a booming voice. You turn to see her husband, head of the pulmonology department at Ivory Tower University. He says, “Tube her you nitwit or I’ll do it myself!”
You ask anesthesia to intubate and she goes to the ICU alive.
You ask anesthesia to intubate and she goes to the ICU alive.
The next morning, doctors come from hundreds of miles around to criticize you and your work.
Why did you intubate her?
Why didn’t you intubate her sooner?
It’s all perfectly obvious what you should have done and it’s obvious to everyone that you are a nitwit.
Why did you intubate her?
Why didn’t you intubate her sooner?
It’s all perfectly obvious what you should have done and it’s obvious to everyone that you are a nitwit.
They make you stand in the middle of Ivory Tower University Stadium in front of 10,000 disappointed doctors and give you 280 characters to defend the decisions you made at 2am the night before. What do you say?
Mine:
At the moment the patient asked for a shock, I had reasonable doubt about the recorded DNR status. She asked for help and I used my judgment & the limited information I had available in the seconds I had to make that decision, erring on the side of usual care.
At the moment the patient asked for a shock, I had reasonable doubt about the recorded DNR status. She asked for help and I used my judgment & the limited information I had available in the seconds I had to make that decision, erring on the side of usual care.
