Directions: Read the following case study and determine whether or the informed

Question

Directions: Read the following case study and determine whether or the informed refusal process was correctly applied Question 1 A 64-year-old male patient presented to emergency department #1 with a headache and neck pain. A CT scan of the brain was obtained and was negative. The physician advised the patient that they should consider the possibility of meningitis, requiring a lumbar puncture to analyze his spinal fluid. The physician stated his suspicion was low for meningitis. The patient stated, “If you are not that concerned, I’m not either.” He declined the lumbar puncture. The patient presented to emergency department #2 via ambulance 48 hours later. He was comatose and was diagnosed with a subarachnoid hemorrhage.menigitis and subarachnoid hemmorhage may have similar presentation, and both can be diagonsed with lumbar puncture.

1. problem affection patient? solution that you recommend for patient?

2. ethical principle supporting your recommended solution? explain why you chose this ethical principle?

3. law/ risk management a. documentation, if any, used in case example. b. documentation that you would recommend and why?

Explanation / Answer

Subarachnoid haemorrhage (SAH) can occur after lumbar puncture (LP) in patients with unsuspected intracranial vascular malformations and this is a serious complication. It is important for anesthesiologists, physicians and neurologists to be aware of this possible complication after LP because this complication has a potentially fatal outcome and because of the medicolegal implications involved. In patients with thunderclap headache, when SAH is not demonstrated in the computerized axial tomography (CT) scan, cerebral angiography should be done. In this situation, LP for cerebrospinal fluid (CSF) examination could be dangerous because this could decrease the CSF pressure with consequent risk of aneurysm rupture.

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