2001 Case 6
How to do life prolonging treatment in a severe
brain hemmorage.

58 years old  Male
The patient fell down suddenly and became unconscious at his office.
It was ponitine hemorrhage and in critical stage.
The dotor said to the family "The operation is impossible. The body
states, such as a respiratory state, would be worsen in the near future".
The family was told this bad information repeatedly from the doctor
in charge and began to accept this bad condition.
In a few days, the respiratory state got worse and oxygen therapy
was started, the family don't want to use respirator to prolong life.
But the venticular fibriration stated suddenly at 11:00 p.m. on the next
day . The ER doctor was called to the ward for resuccitation. The ER
doctor telephoned to the doctor in charge immediately, and consulted
about whether the resuccitation  should be carried out. The doctor in
charge told to the ER doctor that the family could understand the
situation and the resuucitation is not indicated in this case.
However, the family (a wife and two sons) told roudly to the patient
"Hurry Up!" and told to the ER doctor "Please keep her life longer
until the paitient's daughter comes". So the ER doctor carried out the
DC counter shock and a pulse came to touch, but there had still been
sporadic PVCs.
The doctor in charge arrived at 11:30 p.m. and after his talking with
the family, no other resuccitation manuver was carried out and the
patient died at 11:55 p.m.

(Question raised by the medical student)
In a case like this emergency case, what should the ER doctor do?
Was this DC counter shouck not indicted in this case?

If you kindly send your comments on this case, please send it to the
following mail adress.

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Masashi Shirahama M.D.
Director, Mitsuse National health Insurance Clinic
Clinical Professor, Department of General Medicine, Saga Medical School
2615 Mitsuse, Kanzaki Gun, Saga Ken
842-0301 Japan