Awkward conversation last night

[SS Junk]

Pretty sure any patent that has their wits about them can refuse treatment. If not they have to be declared legally incompetent and a power of atty or conservatorship has to be issued. My father had a DNR in his trust, but ultimately it was my decision.

[Sean88gt]

If he's still there tonight....

[Moose242]

Crazy. Morphine is some good stuff.

[davbrucas]

That's one of the most difficult things to deal with in medicine. Have to watch a patient go through the stages of death and dying and not be able to do anything due to the patient and/or family's wishes. I respect their decisions, but it's still difficult to watch.

As far as internal bleeding and not doing anything about it...I would have to hear the circumstances to understand that decision. But some patients will not survive surgery so why put them through the painful process? If a patient has the triad of death (acidosis, coagulopathy and hypothermia) then surgery will kill them 100% of the time. I'm not sure of this patient's situation, but there has to be a reason to not intervene with an actively bleeding patient. DNR does not mean Do Not Treat...it just means that if they go into cardiac arrest, that resuscitation efforts are not instituted. But until that point, most anything is fair game.

[davbrucas]

Crazy. Morphine is some good stuff.

LoL...most of my patients laugh at morphine. They want demerol.

[JC316]

LoL...most of my patients laugh at morphine. They want demerol.

Fuck demerol. I want dilaudid.

[davbrucas]

I'd go with fentanyl.

[Moose242]

LoL...most of my patients laugh at morphine. They want demerol.

I got a healthy dose of the stuff when I had my heart attack. I went from being terrified and in horrible pain to not giving a fuck and finding a rerun of Cheers to be the greatest achievement in American Television.

[davbrucas]

You still never sent me your labs and EKG when you had your "heart attack."

[gonzo]

Internal bleeding for 2 hours?...why couldn't y'all fix him up?

ive seen one with whats called esophageal varicies which are basically ulcers in the esophagus that rupture and bleed. sometimes there are too many of them to stop. they are usually caused by alcohol abuse. alcoholism is a hell of a drug

[Moose242]

You still never sent me your labs and EKG when you had your "heart attack."

Mainly because you said you did not want/need to see them.

[davbrucas]

Mainly because you said you did not want/need to see them.

Oh...ok. My memory fails me in my old age.

[davbrucas]

ive seen one with whats called esophageal varicies which are basically ulcers in the esophagus that rupture and bleed. sometimes there are too many of them to stop. they are usually caused by alcohol abuse. alcoholism is a hell of a drug

I've had an Asian woman come in with this...she looked like something from the Exorcist rolling down the hall to the resusc bay. She had dark blood shooting from her mouth about 2ft (sitting up on gurney). When we laid her down to get control of her airway, the blood was filling her mouth so fast that two suction setups couldnt keep up with it...I got lucky and go the tube in blindly. We then put in a Sengstaken-Blakemore tube to stop the bleeding...but I think she still died in the OR.

[Cooter]

Oh...ok. My memory fails me in my old age.

Time to pull the plug!

[davbrucas]

I have a lot of shit to do before it gets to that point.