Patient with 'Do Not Resuscitate' Creates Organ Donation Crisis | Chicago Med | MD TV

Summary

In a harrowing emergency scenario, two-year-old Abigail and her father, Mark Jones, are victims of a hit-and-run. Abigail sustains a head injury, while Mark faces severe brain trauma. As medical teams fight to save them, the dilemma of honoring Mark's advanced directive tattoo arises, suggesting no resuscitation if he codes. While Abigail’s condition remains critical, there’s hope for her recovery. The hospital forms an ethics committee, and after examining Mark’s situation, they decide to honor his wishes. Ultimately, Mark passes away, leaving Abigail’s fate uncertain, as the medical team is forced to make life-altering decisions.

Takeaways

• 😀 A father and daughter were victims of a hit-and-run accident, with the daughter, Abigail, suffering blunt head trauma and the father, Mark, having suspected spinal injuries.
• 😀 Abigail, aged 2, had a Glasgow Coma Scale (GCS) of 9 and required immediate medical intervention, including intubation and chest x-rays.
• 😀 Despite being unconscious and in critical condition, Abigail's vitals began stabilizing after treatment, including the use of hyperventilation and mannitol for intracranial pressure.
• 😀 Mark, the father, was intubated and unresponsive, with possible brain injuries, and an advanced directive in the form of a tattoo raised ethical concerns about his resuscitation.
• 😀 The hospital's legal team was involved in determining the validity of Mark's tattoo as a legitimate advance directive, with discussions surrounding his family's wishes and the circumstances of his condition.
• 😀 Abigail's brain injury was severe, with CT scans showing diffuse bleeding, and she required ongoing treatment to maintain stability.
• 😀 The medical team debated the possibility of organ donation for Abigail, considering her brain injury and the lack of family consent due to Mark's condition.
• 😀 Ethical dilemmas arose as the medical staff faced the possibility of respecting Mark's tattoo versus doing everything possible to save his life for the sake of Abigail.
• 😀 Mark's brain condition deteriorated, and the decision was made to respect his apparent wishes from the tattoo, leading to his decision to not resuscitate.
• 😀 Ultimately, the Ethics Committee concluded that Mark had no quality of life due to severe brain damage and spinal injuries, and the hospital respected his advanced directive, declaring his time of death.

Q & A

What is the initial condition of Abigail Jones after the hit-and-run accident?

Abigail Jones, a 2-year-old girl, initially presents with a Glasgow Coma Scale (GCS) of 9, blunt head trauma with lacerations, and a left leg injury. However, her condition is stable and she's expected to survive.

What is the main concern regarding Mr. Jones, Abigail's father, after the accident?

Mr. Jones is unconscious with severe head injuries and is intubated. He has a suspected spine injury, and his GCS is 3, which indicates a very low level of consciousness. The medical team is uncertain about the extent of his brain damage and the prognosis.

What does the medical team decide to do to manage Abigail's worsening condition?

The team decides to treat Abigail's rising intracranial pressure with hyperventilation and mannitol. However, her condition deteriorates, leading to a need for further interventions.

What is Cushing's reflex and how does it relate to Abigail's condition?

Cushing's reflex is a physiological response to increased intracranial pressure, which leads to changes in blood pressure, heart rate, and breathing. Abigail's worsening condition triggers this reflex, prompting the need for urgent medical interventions.

What is the significance of Mr. Jones' tattoo, and how does it affect the medical team's decision-making?

Mr. Jones' tattoo, which seems to be a form of an advanced directive, becomes a point of legal and ethical debate. The tattoo may indicate that he does not want to be resuscitated in the event of a terminal condition, complicating decisions regarding whether to continue life-saving treatments.

What is the ethical dilemma faced by the medical team regarding Mr. Jones' treatment?

The medical team is torn between respecting the tattoo as an advanced directive, which suggests no resuscitation if his condition worsens, and the need to try everything possible to save his life for the sake of his daughter, Abigail.

What is Abigail's potential role in organ donation?

If Mr. Jones' tattoo is honored and he is allowed to pass away, Abigail’s organs may be considered for donation. However, this is contingent on Mark's status and whether the hospital can obtain consent, as Abigail would not have a living guardian to give approval.

What factors contribute to the medical team’s decision not to resuscitate Mr. Jones?

The medical team considers Mr. Jones’ probable irreparable brain damage and poor prognosis, as well as his advanced directive indicated by the tattoo. The Ethics Committee concludes that there is no quality of life expected for Mr. Jones, and resuscitation is deemed unnecessary.

What role does the hospital's legal team play in this situation?

The hospital's legal team is involved in determining the legitimacy of Mr. Jones' tattoo as an advanced directive and in navigating the ethical and legal complexities of his care, including decisions about organ donation and life support.

How does the situation conclude for Mr. Jones and Abigail?

Mr. Jones' advanced directive, symbolized by his tattoo, is honored, and he is allowed to pass away after a final code. The decision is made after evaluating his brain injury, and the hospital starts to focus on Abigail's care, including potential organ donation.