Scenario


Consider the following scenario:

A doctor is working in the Accident & Emergency Department of a district general hospital.

An 87-year-old man who had a fall and collapsed at home, sustained a large intra-cerebral bleed and is now intubated and ventilated in the emergency department.

Before the intubation, the patient was deeply unconscious, with a Glasgow Coma Scale of three.

The case was discussed with the intensivists and neurosurgeons at the general hospital, however they felt that the transfer to the ICU is not appropriate as the predicted outcome of the patient is poor.

The doctor is now in a dilemma on the next most appropriate action.


Thus, what do you suggest would be the most appropriate next course of action?

Admit the patient to the ICU for further assessment and review

Consider withdrawal of treatment with extubation, and then transfer to medical ward for palliative care

Discuss with the patient's family