ABSTRACT
The emergency department is where the patient and potential ethical challenges are first encountered. Patients with acute neurologic illness introduce a unique set of dilemmas related to the pressure for ultra-early prognosis in the wake of rapidly advancing treatments. Many with neurologic injury are unable to provide autonomous consent, further complicating the picture, potentially asking uncertain surrogates to make quick decisions that may result in significant disability. The emergency department physician must take these ethical quandaries into account to provide standard of care treatment.
Subject(s)
Brain Injuries, Traumatic/therapy , Terminal Care/ethics , Airway Management/ethics , Airway Management/methods , Beneficence , Brain Death/diagnosis , Brain Injuries, Traumatic/diagnosis , Emergency Service, Hospital/ethics , Endovascular Procedures/ethics , Ethics, Medical , Humans , Informed Consent/ethics , Prognosis , Stroke/therapy , Tissue and Organ Procurement/ethicsABSTRACT
Urgent airway management is challenging because time constraints limit thorough evaluation and planning before endotracheal intubation. In this report, we describe a case in which an airway history review revealed extraordinarily complex airway anatomy that led to a decision not to attempt intubation in a man with end-stage chronic obstructive pulmonary disease. We emphasize the utility of reviewing history and imaging before attempted urgent intubation. We discuss the importance of a multidisciplinary approach that includes the patient, their family, and consultants when high-risk intubation is contemplated. The ethical role of the anesthesiologist is also discussed.
