A 24-Year-Old Bicycle Courier Is Brought to the Emergency Department

A 24-year-old bicycle courier is brought to the emergency department after he was struck by a car.  The patient was thrown approximately 6.1 m (20 ft) through the air and was initially unconscious when other eyewitnesses reached him.  On arrival, blood pressure is 84/54 mm Hg, pulse is 130/min, and respirations are 28/min.  Oxygen saturation is 88% on 100% oxygen via a nonrebreather mask.  The patient appears extremely anxious and in respiratory distress.  When he sees the trauma team preparing supplies for intubation, the patient says, "No, no tube!"  However, soon afterward, the patient loses consciousness while resuscitative efforts and trauma survey examination are ongoing.  Which of the following is the most appropriate course of action?

A) Consult the medical ethics committee emergently
B) Contact the next of kin and obtain surrogate consent for intubation
C) Do not intubate the patient and document his verbal refusal
D) Intubate the patient without obtaining consent
E) Perform tracheostomy instead of orotracheal intubation
F) Proceed with intubation and obtain retroactive consent after the patient recovers

Correct Answer:

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