Wednesday, December 13, 2006

Who decides?

So we have a 40-year-old male in our unit right now who is homeless and was found in a gas station bathroom after an overdose. He was brought to our unit with a GCS of 3. Currently there is decerebrate posturing. EEG shows anoxic brain injury. He is on the vent, overbreathing the rate by about 2-4 breaths per minute. Apparently, he has no family. He is "brain storming" and has seizure-like movements like I've seen with anoxia. So who makes the decisions for this patient? Our attending wants to trach and PEG him, which a lot of the staff feels is inappropriate. The ethics committee is looking for a conservator through the courts, but we aren't sure how long that will take. Who decides whether to trach or PEG this patient? The PICC RNs won't put in a line because there is nobody to consent and he is not critical enough for a doctor emergency consent. Situations like this make my job in the ICU very difficult. What is done at other hospitals? What kind of quality of life will he have with a trach, PEG, and vent dependence? Please share your opinions.

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