[heights]

It seems that the Ethics questions can be a bit tricky on the NBME, so i thought I'd post a couple from a Kaplan book I have.

An unconscious man is brought to the ED for a MVA hemorrhaging profusely, hypotensive and stuporous. You have never met him and no one at your institution knows him. He is wearing a t-shirt that says, "Kiss me, I'm a Jehovah's Witness".
What should you do about the blood transfusion?
a) Give the blood
b) Wait for him to awaken enough to sign consent
c) Wait for the family
d) Seek a court order
e) Give IV fluids alone

Explain your reasoning if you'd like!

 

[ashishkabir]

A) Give him blood- this is an emergency and you have no idea where he got that t shirt... Fluids will stop the hypotension but not the stupor which I'm assuming is from hypoxemia and this is an emergency - treat first.

 

[step1an]

i think the answer should be

a) Give the blood

Reason..

well .. the pt is unconscious we can rely on advance directives but i don't think wearing a Jehovah's Witness t-shirt counts as an advance directive...
So, by following the Best-interest standard, we go ahead & transfuse the pt.

 

[khanar]

Conrad Fischer spoke about this

Conrad Fischer specifically talked about this question.
He said we should not make assumptions from the T-shirt. maybe he just borrowed it from a friend or maybe he's joking ...etc
The only thing that we just follow is advanced directives or a legal power of attorney from a family member.
Of course remember that in children we give the blood no matter what the parents are adamant about it.

 

[heights]

Conrad Fischer specifically talked about this question.
He said we should not make assumptions from the T-shirt. maybe he just borrowed it from a friend or maybe he's joking ...etc
The only thing that we just follow is advanced directives or a legal power of attorney from a family member.
Of course remember that in children we give the blood no matter what the parents are adamant about it.

Yes the answer is A. give blood.

So should you give blood if the parents are Jehovah's Witness and say they do not want their child to get blood?

 

[step1an]

Yes the answer is A. give blood.

So should you give blood if the parents are Jehovah's Witness and say they do not want their child to get blood?

Parents cannot withhold life or limb saving surgery/procedure/medication from their children...... its irrelevant whether they are Jehovah's Witnesses or not.

 

[omarm]

Definitely A
same reasons as above

 

[Ngozi]

Give the blood. its an emergency. the guy may never wake up to sign the consent if u don't do anything.

 

[khanar]

So should you give blood if the parents are Jehovah's Witness and say they do not want their child to get blood?

Oh. Yes. The parents can't withhold a life-saving measure of their child.

 

[fin-84]

hear hear. Give the blood, that is my opinion in this situation. You cannot be sure this patients opinion when patient is unconscious.

 

[mtoi]

give blood, under the provision of implied consent

 

[busterbee]

Jehovah witness and blood transfusion

there is this question in uw Q 3616 regarding blood transfusion in emergency life threatening situation in Jehovah witness...wife says dont transfuse...
shouldn't the transfusion be stopped ...isn't wife or spouse speaks of patient's wishes....

 

[step1an]

I havn't seen this question yet but my understanding of the issue is that,

Usually the devout Jehovah's Witnesses carry an Advance Medical Directive card, mentioning their desire not to be transfused.

If this card or a similar legal document like living will is presented clearly stating that they dont want to be transfused even in case of a life threatening need then we can stop the Blood transfusion.

Otherwise we cannot be sure whether the pt would have consented to blood transfusion or not. We should follow the best interest standard & continue the blood transfusion.

 

[cool_atomic]

how do you know the truth if the pt. is a jehovas witness for SURE? maybe the wife is planning to get him killed? seriously, if you are not 100% sure that he is one, carry on with the best interest standard.

 

[plasticsurgeon]

a) Give the blood
Vs.
e) Give IV fluids alone

If the patient needs blood to survive......

Give the blood so as to save his life

 

[busterbee]

thanks guys
[/LIST]

 

[fhilkmvtw]

thank you all for the information
but I have a question: what is the age range for children?

 

[riya10]

It seems that the Ethics questions can be a bit tricky on the NBME, so i thought I'd post a couple from a Kaplan book I have.

An unconscious man is brought to the ED for a MVA hemorrhaging profusely, hypotensive and stuporous. You have never met him and no one at your institution knows him. He is wearing a t-shirt that says, "Kiss me, I'm a Jehovah's Witness".
What should you do about the blood transfusion?
a) Give the blood
b) Wait for him to awaken enough to sign consent
c) Wait for the family
d) Seek a court order
e) Give IV fluids alone

Explain your reasoning if you'd like!

a) Give the blood....

 

[ak_nz]

a) Give the blood