Your first day as a doctor

Original post by junior.doctor

Armed with those facts most people would say "don't jump on granny's chest and break all her ribs".

Most people would also say that euthanasia and assisted suicide are illegal in this country.

Reply 301

birduk

Original post by electricjon

The family start screaming "Do something."

Original post by electricjon

The family just want her to die with dignity

So which is it? Do they want her to die with dignity or do they want to witness me doing CPR on her for the next few minutes? I'd still go with the CPR until no signs of life, but it still seems that the breathing spontaneously indicates that there is something left in her. DNAR has not been signed so we still have to try surely?

Reply 302

I think you're starting to get a little TOO devil's advocate here! This situation wouldn't have happened OOH without a senior around as it's an elective extubation - that decision simply wouldn't have been made at 4am unless there was a boss in from home already. If we're talking more general CPR decisions at 4am, you should start CPR and call the 2222 and then make a decision together as a team. You can only hope that most people who need one might have had a form done before the point of arresting, but if we're still going with the fact that the doctor here is an FY1, then an FY1 certainly shouldn't be making CPR decisions.

Reply 303

Original post by electricjon

Most people would also say that euthanasia and assisted suicide are illegal in this country.

Are you suggesting that not performing CPR in this case would be euthanasia? I would certainly disagree.

Reply 304

Original post by birduk

They don't want her to suffocate to death, nor do they want to remember her as dying with people jumping on her chest, shocking her and intubating her. Is there a third option?

Reply 305

Original post by electricjon

Lets say it's 4am, and you are the most senior doctor around. The family just want her to die with dignity.

See no offence but this is where your case scenario falls. 4am in ITU an f1 would not be the only senior doctor around and there would be tons of nurses next to you with years of experience in critical care and have seen similar experience and a nice emergency button to press or even a 'can I have some help over here' would be more than suffice.

I'm sorry but I'm starting to feel as much as cases are interesting (and highlight assessments and plans needed) it is coming across you're doing this to show off...with a hint of arrogance maybe? I just think you need to remember that there are medical students/applicants in the early stages and it's coming across as patronizing a bit.

Just my two cents, but you need a bit if reality if you're going to do this!

(edited 13 years ago)

Reply 306

Original post by junior.doctor

The senior doctor (i.e. the intensivist) has said he'll "be right back" and has left you, the FY1, by yourself with the patient.

Reply 307

Entangled

Maybe I'm overstepping it a bit, but resedating her?

Reply 308

Original post by junior.doctor

Are you suggesting that not performing CPR in this case would be euthanasia? I would certainly disagree.

It would certainly look very dodgy in the coroner's court. A good enough lawyer could easily pin a manslaughter charge on you.

(edited 13 years ago)

Reply 309

Original post by Subcutaneous

See no offence but this is where your case scenario falls. 4am in ITU an f1 would not be the only senior doctor around and there would be tons of nurses next to you with years of experience in critical care and have seen similar experience and a nice emergency button to press or even a 'can I have some help over here' would be more than suffice.

I'm sorry but I'm starting to feel as much as cases are interesting (and highlight assessments and plans needed) it is coming across as your arrogant, and we ALL know less than you...

Just my two cents, but you need a bit if reality if you're going to do this!

You're in A&E, not ITU, in a small DGH. The scenario seems perfectly reasonable to me. Bit of a harsh criticism mind...

Reply 310

birduk

I disagree Subcutaneous. I am finding this really interesting. It's like a little puzzle. Imagine you are playing Professor Layton!

Third option eh? I don't have one. Anyone else? She needs help to breathe- we all assumed CPR, but nowhere does it say her heart has gone (yet), so back to ventilation- oxygen and OPA?

Reply 311

Original post by electricjon

The senior doctor (i.e. the intensivist) has said he'll "be right back" and has left you, the FY1, by yourself with the patient.

Then chin tilt jaw thrust with a bag and O2 on till he returns- shows an attempt to keep airway clear. Still wouldn't be the only doctor around though....

Reply 312

Original post by birduk

I'm not saying it's not, but I think he should come to reality slightly and maybe lay off the slight arrogance that someone else also picked up on earlier

(edited 13 years ago)

Reply 313

Original post by electricjon

The senior doctor (i.e. the intensivist) has said he'll "be right back" and has left you, the FY1, by yourself with the patient.

Ok, well even if we're going with the fact that the doctor is an FY1 (almost nowhere do FY1s do ITU nights - most of them are on the surgery rota for OOH calls) then the nurses in ITU are going to be a lot more experienced in ITU than that doctor - get some help from wherever / whoever. Pull the red button and people will come running, and whether they're ITU nurses or doctors, they all almost all know more than the FY1.

Reply 314

(and heh, with all this ITU talk, I'm off to bed - I'm doing nights on ITU tonight and should probably get some sleep...)

Reply 315

Original post by junior.doctor

Lol your post is almost identical to mind earlier. I'd like to know why an elective extubate was being done in A&E too...

Just finished 2 long days on neuro ITU myself and back in Saturday...spending the whole of today in bed recovering!

Reply 316

Original post by Subcutaneous

I'm not saying it's not, but I think he should come to reality slightly and maybe lay off the slight arrogance that someone else also picked up on earlier

Honestly Subcutaneous you need to lighten up a bit. I'm not trying to wind anyone up here. Yes I'm playing devil's advocate. There aren't really any right or wrong answers. I'm not forcing anyone to take part in the discussion, and if you take offence to my answers then I do apologise, but then my suggestion would be to not contribute, particularly if you are going to make resentful comments.

I'm not pretending I'm above anyone. But as someone who has had to deal with these situations in one form or another, however arbitrary or modified, I find your comments quite offensive.

Reply 317

And we're in A&E, not ITU!! Lots of foundation doctors are the only doctor on during night shifts!

Reply 318

Original post by electricjon

I'm not saying they're offensive, just slightly patronizing and unrealistic...but I do know to the applicant they're interesting, but I guess they wouldn't necessarily know the reality, hence why I'm finding them slightly frustrating. Sorry if you've taken offense...

Plus I'm annoyed that I said munchausens in the last scenario, yet you kept us guessing and it got on my nerves cause I knew I was right but you made me doubt my intuition! :tongue:

Reply 319