Work in pairs. Read the scenarios and answer the questions. Then compare your opinions and decisions with other students in your class.

 

1. You are about to save a patient's life with a large dose of a scarce drug - the patient will certainly die without it. It is the only supply of the drug that the hospital has. Suddenly three more patients are brought in to A&E. Each one needs one third of the drug and without it they will probably (though not definitely) die. Who should have the drug?

2. The ICU is full, but there is one patient who is relatively stable though still requiring ICU for optimum care. A new patient is brought in. These are his notes.

 

CLINICAL RECORDS   Patient: 32-year-old man Dx: meningitis Presenting symptoms: unconscious, extremely low blood pressure, evidence of renal failure. Grave condition - urgently requires intensive care

 

 

There is a bed in an ICU in another hospital 80 kilometres away but moving a patient from an ICU early increases risk of complications and death. Should you transfer the new patient to the other hospital or move the existing patient out of ICU?

 

1. In a high-speed car chase, a criminal crashes into a police car. The police officer suffers a fractured femur. The criminal hits the windscreen with his head - a serious BHT. The air ambulance has room for one. Who should it be?

 

Tape script

Operator:	Emergency services. Which service do you require?
Caller:	Ambulance, quick!
Operator:	Connecting you.
Ambulance dispatcher:	Ambulance emergency. What number are you are calling from?
Caller:	There’s been a terrible accident.
Ambulance dispatcher:	OK, caller. Can you first give me your number so if we get cut off, I can call you back?
Caller:	I'm on a mobile. It's zero zero seven nine double three triple six.
Ambulance dispatcher:	And where is the emergency?
Caller:	Here just outside my house.
Ambulance dispatcher:	It's OK Sir, keep calm. I need to know where. Are you at the scene now?
Caller:	Yes.
Ambulance dispatcher:	Where are you?
Caller:	I'm on Second Avenue in Newtown.
Ambulance dispatcher:	Second Avenue, right. And your name?
Caller:	Alexander. Alexander Petit.
Ambulance dispatcher:	OK, Alexander. Tell me what's happened.
Caller:	A lorry. It’s a tanker. It was this terrible noise. A big crash and the shop wall fell down. The driver - he doesn't look good.
Ambulance dispatcher:	Try to calm down, Alexander. Now let’s take it slowly. You say that a tanker has crashed into a shop?
Caller:	Yes.
Ambulance dispatcher:	In Second Avenue?
Caller:	Yes. Is an ambulance coming?
Ambulance dispatcher:	It’s on its way now, don't worry. But I need some information from you to give to the ambulance crew. Tell me who has been injured.
Caller:	The driver's been thrown out of his cab. He's not moving and I think someone in the shop has been hurt too. It’s Mrs. Williams, I think. A wall has fallen on her and there's a lot of blood coming from her head. She's not moving. The driver doesn't look good. My God! I think he's having a heart attack.
Ambulance dispatcher:	What about the tanker? Do you know what it’s carrying?
Caller:	No, but there's some liquid leaking from the back. It smells like petrol.
Ambulance dispatcher:	Hello, Alexander?
Caller:	Hello. I can hear the ambulance now.
Ambulance dispatcher:	Alexander, just stay on the line a little longer until it arrives. Now what I want you to do is...

 

Tape script

 

Police officer:	Oh, nurse. Do you have a moment? Could I talk to you about the accident last night?
Nurse:	The RTA in Second Avenue?
Police officer:	Yes, that’s it. Can I speak to the lorry driver?
Nurse:	You can't I'm afraid. He died in the ambulance on the way in.
Police officer:	Oh. I see. Cause of death?
Nurse:	Myocardial infarction. He had a heart attack. The ambulance crew tried CPR but no luck, which is not surprising, considering his age and condition.
Police officer:	How old was he?
Nurse:	In his late fifties.
Police officer:	So he wasn't very well? What makes you think that?
Nurse:	He had a GTN spray in his pocket.
Police officer:	GTN?
Nurse:	Glyceryl Trinitrate - it's a medication for angina.
Police officer:	I see. I'll make a note of that: Glyceryl Trinitrate. Do you think his medication could have affected his driving?
Nurse:	It’s possible, yes.
Police officer:	What about the other casualty? That was a woman, according to my information.
Nurse:	Yes, Mrs. Williams. She was in her front room when the tanker crashed into the wall. She's in a critical condition. Multiple injuries; two fractured ribs, perforated liver, and lung contusion. She's in ICU.
Police officer:	Can I talk to her?
Nurse:	You'll have to ask the doctor about that.
Police officer:	Right. I'm not getting very far, am I? What about witnesses? Who called for the ambulance?
Nurse:	A neighbour. His name is Petit, I think. The dispatcher will have his details.
Police officer:	Right
Nurse:	Do you know what caused the accident?
Police officer:	It’s hard to say at the moment. It was half past one in the morning. It was very quiet. The road is straight; there are no junctions. Suddenly the lorry swerved across the road and drove straight into a shop. Perhaps the driver fell asleep. Perhaps there's something wrong with the vehicle. I'm just guessing at the moment and we may never know.

Textsforindependentstudying / Тексты для самостоятельного изучения

Learn these abbreviations

cap	capsule
g	gram
mg	milligram
mm	millimetre
PO	orally
tbsp	tablespoon
tds	three times daily
tsp	teaspoon

 

 

Measures to diminish the risk of lawsuit

 

1. Do an accurate nursing assessment. (Know your client.)

2. Follow up on laboratory reports.

3. Document timely and thoroughly during the course of care (document, document, document).

4. Do not alter the chart. (Avoid even the appearance of negligence.)

5. Read the nurse's notes, the laboratory reports, and the physician's progress notes.

6. Do not promise the impossible to clients.

7. Do not ignore a dissatisfied client. (Maintain communi­cation and exercise courtesy. Make sure you maintain good client relations.)

8. Do not point fingers when something goes wrong. State the facts. (Facts in incident reports should match those in the medical record.)

9. Do not overreach your training and ability. (Stay within the limits of your experience.)

10. Know your institution's policies and procedures.