TYK108
While obtaining consent for a tonsillectomy and adenoidectomy on a 5 year old girl, her parents inform you that they are Jehovah’s Witnesses and will not give consent for their child to receive any blood products. You inform them that the likelihood of transfusion is very low but reaffirm that in an emergency it is your obligation to act in the best interest of the child. The parents reluctantly give you consent for anesthesia and the case proceeds. Thirty minutes into the procedure, you suddenly see bright red blood shooting from the patient’s mouth and you hear the resident say that he has cauterized through to the carotid vessels. Despite several fluid and vasopressor boluses, the patient becomes hypotensive with a blood pressure of 40/20 and tachycardic and the surgeons are still struggling to control the bleeding. You realize that this child’s survival depends on a blood transfusion.
What is your next step?
a) Call the parents in the waiting room and request verbal permission to emergently give blood
b) Contact your hospital’s attorneys and ask them to request an emergent court order to circumvent parents’ wishes so that you may give a blood transfusion
c) Call the blood bank and ask them to release emergency blood products that you will then administer immediately to the patient
d) Respect the parent’s wishes and continue with vasopressors and fluid boluses only
Answer
Answer c.
The parents have denied permission to administer blood products for a case that is considered low risk for blood loss. The case has now changed into an emergency situation with hemorrhagic shock, and the physician should not delay treatment. It is in the best interest of the child to transfuse blood as needed, and both the medicolegal system and experts in medical ethics have supported this action.
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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