Glad I managed to avoid this case,,,
96 y/o lady brought to pre-op for hip hemiarthroplasty for hip fx. Nursing home resident. History in our antiquated computer system is scant and all we know is she has rate controlled A-Fib, with an EKG to that effect, HTN, and dementia that has been "worsening over time" She is thin, somnolent and chronically ill appearing but vitals are stable with a normal cxr the hospitalist ordered.
I tried to pre-op this lady which was very difficult. She was oriented to person and place but told me the year was 1946. She was able to converse and make sense maybe 60% of the time and even though she was able to articulate that she had broken her hip and was in the hospital for a "hip replacement surgery" I did not think she was capable of truly giving informed consent. Per hospitalist, her only next of kin was in the hospital herself and about to die and no attempt made to contact anyone else. The lady was able to tell me she had a son that was in another country but couldn't provide any other info.
So this lady is also DNR/DNI...trying to discuss this with her was extremely difficult and while she did say "if something happens may as well let God take me" she was not able to understand the concept of rescinding the DNR for surgery as an option.
How would you all proceed? Medicine has "cleared" the patient, with no other workup. Surgeon got the lady to scribble a line on the surgical consent but then decided to do a two physician consent saying this case was emergent and she would die without it. OR is all set up to go and everyone is waiting on you to bring her back.
I'll just say what happened...a coworker relieved me while I was pre-opping. Proceeded with the case and DNR status was ignored; patient coded at the end of the case. The anesthesiologist gives rounds of epi and staff give chest compressions and manage to get her back after several minutes and she is dropped off in ICU on a vent, put on levophed to barely keep bp above 90.
96 y/o lady brought to pre-op for hip hemiarthroplasty for hip fx. Nursing home resident. History in our antiquated computer system is scant and all we know is she has rate controlled A-Fib, with an EKG to that effect, HTN, and dementia that has been "worsening over time" She is thin, somnolent and chronically ill appearing but vitals are stable with a normal cxr the hospitalist ordered.
I tried to pre-op this lady which was very difficult. She was oriented to person and place but told me the year was 1946. She was able to converse and make sense maybe 60% of the time and even though she was able to articulate that she had broken her hip and was in the hospital for a "hip replacement surgery" I did not think she was capable of truly giving informed consent. Per hospitalist, her only next of kin was in the hospital herself and about to die and no attempt made to contact anyone else. The lady was able to tell me she had a son that was in another country but couldn't provide any other info.
So this lady is also DNR/DNI...trying to discuss this with her was extremely difficult and while she did say "if something happens may as well let God take me" she was not able to understand the concept of rescinding the DNR for surgery as an option.
How would you all proceed? Medicine has "cleared" the patient, with no other workup. Surgeon got the lady to scribble a line on the surgical consent but then decided to do a two physician consent saying this case was emergent and she would die without it. OR is all set up to go and everyone is waiting on you to bring her back.
I'll just say what happened...a coworker relieved me while I was pre-opping. Proceeded with the case and DNR status was ignored; patient coded at the end of the case. The anesthesiologist gives rounds of epi and staff give chest compressions and manage to get her back after several minutes and she is dropped off in ICU on a vent, put on levophed to barely keep bp above 90.