TYK109

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

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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