A 65-Year-Old Man Is Brought to the Emergency Department by a Friend

A 65-year-old man is brought to the emergency department by a friend who found the patient disoriented in his apartment.  The patient's medical history includes chronic obstructive pulmonary disease, hypertension, coronary artery disease, and tobacco use.  He is unmarried and lives alone.  The friend says that the patient has a sister who lives in the area but is unaware of when they last spoke.  The friend has known the patient for 5 years and says that they are "good buddies."  He tells the physician that they have discussed dying and that he believes the patient would prefer to "go naturally" and would refuse any heroic measures, including "being hooked up to a ventilator."  Temperature is 39 C (102.2 F) , blood pressure is 120/80 mm Hg, pulse is 105/min, and respirations are 24/min.  Oxygen saturation is 88% on room air and 93% on 2 L of oxygen.  The patient is somnolent and unable to answer questions.  The lungs have bilateral wheezing and decreased breath sounds.  Chest x-ray reveals a right lower lobe infiltrate.  Appropriate bronchodilator and antibiotic therapies are initiated.  The physician is concerned about the need for intubation if the patient does not respond to initial treatment in the next 2-3 hours.  Which of the following is the most appropriate course of action?

A) Attempt to contact the patient's sister for consent to intubate
B) Consult the hospital ethics committee
C) Do not intubate based on the friend's report of the patient's wishes
D) Plan to proceed with intubation when the need arises
E) Wait to see if the patient's condition improves on therapy and he can sign consent

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free