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metawikimedia>DrBobGreenberg at 20:14, 8 July 2015

2015-07-08T20:14:24Z

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You have been asked to cover an emergent case coming from the emergency department. A 13-year-old boy has a fracture which occurred during a football game at school. He has been accompanied by the school nurse as his parents are both at work and you are unable to reach either parent by telephone. The orthopedic surgeon contacts you and states that this case must proceed immediately as they are concerned that the child’s affected extremity may have compartment syndrome. The child is transported to the operating room and upon arrival is upset and screaming. He tells you that he “does not want surgery” and that “he is old enough to make his own decisions”. He continues to protest and physically resist your attempts and states that “his dad is a lawyer and we’ll sue
you for assault”.

What is your next step?

a) Delay surgery while you continue attempts to contact the patient’s parents to obtain verbal telephone consent

b) Respect the patient’s wishes and refuse to administer anesthesia

c) In the best interest of the child, sedate and anesthetize the child for the emergent procedure

d) Call risk management and await their advice in how to proceed with this situation

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==Answer==
Answer c.

In this complicated situation, the best answer would be to proceed with
the emergent procedure. The time sensitive issue this case, specifically the risk of
loss of a limb due to neurovascular compromise, warrants rapid action by the
physician in the best interest of the child. Delaying the procedure with continued
attempts to reach parents or legal professionals would expose the patient (and
the physician) to risk for failure to act within the standard of care. After the
patient is stabilized, a discussion with hospital risk management is warranted in
most cases.

==Notes==
<references />

:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
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WikiSysop: 1 revision imported

metawikimedia>DrBobGreenberg at 20:14, 8 July 2015