Post on 18-Dec-2015
transcript
4 years old boy
Wt. 14Kg
elective adeno - tonsillectomy
Eczema and AsthmaMultiple allergies (milk, sesame, strawberry, eggs, peanut and possible other food items) and Omnicef
Preoperatively
discussed with his parents the issues of allergy in details, Informed them re-drugs contains food extract
super anxious mother
DiscussionInformed consent = Risks & benefits to discuss Known risks i.e. rare but the detriment severe common but the detriment slight
Examples:
Common adverse effects of GA:
nausea, vomiting, sore throat.
Less common but not rare adverse effects
spinal headache and dental trauma
Rare adverse effects which are unpredictable
anaphylaxis, awareness, neurological damage or death
in healthy people
Adverse effects related to pre-existing disease
death in a patient with recent myocardial infarction
undergoing emergency surgery
inhalation of Sevoflurane with 100% O2
Fentanyl 20 mcgPropofol 20 mg Dexamethasone 4 mgMetoclopramide 4 mg Easy intubation
severe bronchospasmrapid desaturationrapid bradycardia
call for help was initiatedCPR + adrenaline + fluids
sPO2 15%-100% , lasts for 7minbradycardia last for 3min
extubated in the OR
PACUbreathing spontaneously O2 Saturation 92-98% on RA
Fully conscious and talking
Parents were called and informed Referred to the pediatrician to follow up
Referred to Allergy Clinic
Communication in difficult situations
do the job well = rehearse
Minimise long term distress in relatives and doctor
Minimise the risk of litigation
Maximise the eventual acceptance of bad news
If a potential medico-legal implications:
ensure information is supplied to insurers
internal hospital protocol is followed
It is important:
To expressing sympathy and regret for the situation of the patient
No explicit admission of liability of blame should be made
Private room, free from interruption
Establish what to call him/her
All must be sitting, at same level
Ensure body language is appropriate
Check the knowledge of the person(s)
Fire a warning shot to give the person(s) time to prepare his/herself:
“I’m afraid I have bad news…”
Allow pauses for the news to sink in
Deliver confirmed information
Do not use jargon
Allow pauses at all steps for:
- reflection
- for the news to sink in
- express emotions and concerns
Express sympathy without accepting any blame for the incident
Verbalise acceptance of person’s emotional responses
“I can see that this is very distressing for you..”
Check the person’s understanding
“Would you like me to repeat that ?.......tell you more ?....
Elicit concerns and information needs
“Do you feel I have covered all your concerns ?...