Mrs. Jones is an 88-year-old demented nursing home resident who is admitted to the hospital one night with dehydration and a urinary tract infection that may have spread to her bloodstream. The resident on duty treats aggressively with IV fluids and also obtains a “do not resuscitate” (DNR) order. Mrs. Jones subsequently develops rales in her lungs that suggest heart failure. She also develops bradycardia down to about 45 beats per minute. Her systolic blood pressure drops to 60 mm Hg with the bradycardia. Mrs. Jones’s condition is likely terminal but the bradycardia can be corrected with a transvenous pacemaker. The family is equivocal, suggesting that the physician do whatever can help. After a family conference and an ethics consultation, the physician decides that Mrs. Jones deserves a pacemaker. She arrests in the recovery room after the procedure and cannot be resuscitated.
KeywordsThreshold Model Juvenile Rheumatoid Arthritis Standard Gamble Perfect Health Ethic Consultation
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