Is there an evidence-based approach for the management of comatose patients?
To propose an evidence-based approach for the clinical management of the comatose patient. Data source: Search of Medline and Cochrane databases; manual review of bibliographies from selected articles and monographs.
What are the preferences of patients?
Patient Preferences This chapter discusses the second topic that is essential to the analysis of an ethical problem in clinical medicine, namely, the preferences of patients. By preferences of patients we mean the choices that persons make when they are faced with decisions about health and medical treatment.
Who is the author of the ED approach to comatose patients?
Author: Paul Trinquero, MD (EM Resident Physician, PGY-2, NUEM) // Edited by: Laura Alkhawam, MD // Expert Commentary: Abra Fant, MD Citation : [Peer-Reviewed, Web Publication] Trinquero P, Alkawham L (2016, August 30). The ED Approach To The Comatose Patient [NUEM Blog. Expert Commentary By Fant A].
What must the physician be confident that medical interventions are acceptable?
The physician must be confident that medical interventions are acceptable to the patient. As a moral principle, respect for autonomy is a “two-way street”: the autonomy of physicians to act only on their best judgment about how best to benefit a patient medically, must also be respected.
What are four ethical considerations when dealing with a critically ill person?
Abstract. Care of critically ill patients, as in any other field, demands the exercise of ethical principles related to respect of patient's autonomy, beneficence, nonmaleficence, and distributive justice.
How do you treat patients ethically?
There are four pillars of medical ethics which are defined as follows:Autonomy – respect for the patient's right to self-determination.Beneficence – the duty to 'do good'Non-Maleficence – the duty to 'not do bad'Justice – to treat all people equally and equitably.
What are the 4 ethical considerations?
There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence.
What are the three basic principles of clinical ethics?
Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed.
Which of the following ethical principles is related to treating the patient with equality?
The Principle of Justice. Justice speaks to equity and fairness in treatment. Hippocrates related ethical principles to the individual relationship between the physician and the patient.
What ethical principle of medicine would you consider to be most important?
Beneficence and non-maleficence often link together, and this is no exception. The most beneficial thing to do may be to provide the patient with the treatment they need.
What are the 5 basic ethical principles?
Moral Principles The five principles, autonomy, justice, beneficence, nonmaleficence, and fidelity are each absolute truths in and of themselves. By exploring the dilemma in regards to these principles one may come to a better understanding of the conflicting issues. 1.
What are examples of ethical considerations?
Ethical considerationsInformed consent.Voluntary participation.Do no harm.Confidentiality.Anonymity.Only assess relevant components.
What are the 7 principles of healthcare ethics?
This approach – focusing on the application of seven mid-level principles to cases (non-maleficence, beneficence, health maximisation, efficiency, respect for autonomy, justice, proportionality) – is presented in this paper. Easy to use 'tools' applying ethics to public health are presented.
What is an example of beneficence?
Beneficence is defined as kindness and charity, which requires action on the part of the nurse to benefit others. An example of a nurse demonstrating this ethical principle is by holding a dying patient's hand.
What specific principles for conduct can be used to guide ethical decisions?
The main principles for conduct which can be used to guide ethical decisions include; the Golden Rule, Immanuel Kant's Categorical Imperative, Descartes' rule or change, the Utilitarian Principle, the Risk Aversion Principle, and the ethical "no free lunch" rule.
What is beneficence principle?
The principle of beneficence is a moral obligation to act for the benefit of others.
What is the importance of autonomy in clinical ethics?
In clinical ethics, respect for the autonomy of the patient signifies that physicians' judgments about how to benefit their patients should never ignore or override the preferences of those patients. Patients have the right to freely accept or reject physician's recommendations.
What is the principle of autonomy?
The Principle of Respect for Autonomy. Respect for autonomy is the guiding ethical principle of the Topic of Patient Preferences. Respect for autonomy is one aspect of a larger principle, namely, respect for persons, which is a fundamental principle of all morality.
Do physicians have to respect patients?
While physicians must always respect the autonomy of their patients, in practice, many forces may obstruct and limit the ability of patients to express their preferences. In clincal ethics, respect for patient preferences takes place within a therapeutic relationship, that is, when some health problem prompts a patient to seek help ...
When does respect for patient preferences take place?
In clinical ethics, respect for patient preferences takes place within a patient-doctor relationship, that is, when some health problem prompts a patient to seek help from a physician and a physician responds with diagnosis, advice, and a proposed treatment.
What is the importance of autonomy in clinical ethics?
In clinical ethics, respect for the autonomy of the patient signifies that physicians’ judgments about how to benefit their patients should include the values of the patients themselves. Physicians must never ignore or override the preferences of their patients.
What is the principle of respect for autonomy?
Respect for autonomy is the guiding ethical principle of the Topic of Patient Preferences . Respect for autonomy is one aspect of a larger principle, namely, respect for persons, which is a fundamental principle of all morality. Respect for persons affirms that each and every person has moral value and dignity in his or her own right. In this sense, the principle of respect applies to every encounter between persons, regardless of their situation, stage, or state of life. One implication of respect for persons is a respect for personal autonomy, that is, acknowledging the moral right of every competent individual to choose and follow his or her own plan of life and actions.
What is the implication of respect for persons?
One implication of respect for persons is a respect for personal autonomy, that is, acknowledging the moral right of every competent individual to choose and follow his or her own plan of life and actions. + +.
When did the preference of the individual prevail?
In a 1986 statement, the Council on Ethical and Judicial Affairs of the American Medical Association said: ''The preference of the individual should prevail when determining whether extraordinary life-prolonging measures should be undertaken in the event of terminal illness.
Who is the director of chaplaincy at Stony Brook?
But there are those like the Rev. Robert Smith, director of chaplaincy at Stony Brook and also a member of the Governor's Task Force, who feel that ''unfortunately, people will think that 'living wills' are a magic force if such legislation is passed in New York.
Does the Times edit or update?
To preserve these articles as they originally appeared, The Times does not alter, edit or update them.
Does a patient lose their constitutional rights if he is comatose?
According to State Supreme Court Justice Bernard F. McCaffrey, ''One must realize that a patient doesn't lose their constitutional rights if he is comatose. ''It is unnecessary and, in some respects, insensitive to compel a patient to undergo litigation to enforce their rights in the courts.
What is it called when a patient does not respond to a question?
If patients do not respond, the condition used to be called “vegetative”; they appear to be unconscious. If a patient responds but is unable to communicate, we categorize the consciousness as “minimal.”. Such patients may, for example, follow a person with their eyes or answer simple questions.
What does the physician say when a patient is in a brain scanner?
Well, of course, the physician will say, “Squeeze my hand” —but this time while the patient is in a brain scanner. If the motor cortex is activated, we know that the patient heard and understood and therefore is conscious.
How long does a coma last?
At most, a coma lasts for a few days or weeks. As soon as patients open their eyes, they are said to “awaken” from the coma. This does not, however, mean that a person is conscious. Most patients who awaken from a coma soon recuperate.
Can a locked in patient move?
In other words, their motor and mental abilities are limited. Locked-in patients can’t move either, but they are completely conscious. They have suffered a particular type of injury to the brain stem.
What should a comatose patient's physical exam be focused on?
The physical exam in the comatose patient should be focused on identifying reversible causes of their depressed mental state as well as assisting with appropriate laboratory and imaging work up.
What does it mean when you are fully comatose?
A fully comatose state implies dysfunction either in both cerebral cortices or dysfunction of the brainstem where the ascending RAS fibers originate. Importantly, localized, unilateral lesions in the cortex, such as a cerebrovascular accident (CVA), tend not to induce a coma, unless there is massive herniation.
What is the difference between coma and stupor?
Stupor describes a patient that will only arouse to vigorous and repeat ed stimuli and immediately lapse back into unconsciousness as soon as undisturbed. Coma is a state of unarousable unresponsiveness, the far end of the spectrum.
What is coma in ED?
Approximately 3% of all ED patients arrive in some sort of altered mental state. The differential diagnosis is broad, but initial evaluation should center on treating any reversible causes and attempting to differentiate a structural brain lesion from a more systemic toxicity. Approximately 85% of altered mental status cases are caused by metabolic or systemic derangements. Structural lesions cause 15% of cases.
What is the combination of orientation, judgment, and memory?
Cognition is the combination of orientation, judgment, and memory. The structures responsible for these crucial components of cognition are spread throughout the cerebral cortices. Therefore, in order to be awake, aware of our surroundings, and fully oriented, we require intact cerebral cortices and an intact RAS.
Why is CT brain imaging important for ED?
CT brain (noncontrast): the mainstay of ED imaging for AMS/coma because of its availability and efficiency. Although evaluation of the posterior fossa is often limited due to artifact from the skull base, this test can reveal the vast majority of ICH that are large enough to cause a coma.
Is hyperthermia a secondary etiology?
Be sure to obtain a rectal temperature. Hyperthermia usually signifies infection but one should also consider heat stroke or anticholinergic intoxication. Hypothermi a may be accidental or secondary to less common etiologies as ad renal failure, hypothyroidism, sepsis, or drug/alcohol intoxic ation.