Sean Marks

Suicide attempts in the terminally ill #210.

It is a core obligation of physicians to prevent a patient from initiating suicide and to intervene medically to prevent a patient from dying after a suicide attempt. This obligation can include detaining and restraining patients against their will and the use of invasive medical interventions such as mechanical ventilation if needed, although such restrictions to a patient’s liberty should be kept to the minimum necessary. Most suicidal patients are considered impaired by depression or other mental illnesses and their actions are not considered autonomous, thus justifying detaining patients and providing medical interventions against their will. Such interventions can create further opportunities to treat the patient’s psychiatric condition, and only 20% of people who are prevented from committing suicide subsequently complete another attempt.

Case Report: Are Clinicians Obligated to Medically Treat a Suicide Attempt in a Patient with a Prognosis of Weeks?

BACKGROUND There is broad ethical and professional consensus that preventing a patient from initiating or successfully completing a suicide attempt is a core physician obligation and justifies the use of aggressive interventions such as emergency detention and mechanical ventilation. This case examines the acute medical care of an individual with a progressive brain tumor after an apparent suicide attempt. RESULTS In guiding the care of this patient, we found that the patients prognosis of days to weeks made the ethical rationale of implementing aggressive medical interventions to treat the sequelae of his suicide attempt less compelling.

Oral versus Intravenous Acetaminophen #302

Acetaminophen (Tylenol) is one of the most commonly prescribed analgesics. Until recently, only oral and rectal formulations were available in the United States. In 2010 the FDA approved intravenous (IV) acetaminophen (Ofirmev) for treatment of mild to moderate pain, fever, and as an opioid adjunct for moderate to severe pain. This Fast Fact will examine the clinical role of IV acetaminophen and compare its efficacy with oral acetaminophen.

Surgery without a surrogate: the low prevalence of Healthcare Power of Attorney documents among pre-operative patients

ABSTRACT Background: There has been little published research regarding the implementation of healthcare power of attorney (HCPOA) documents prior to elective surgery. Objectives: This study aims to determine the prevalence of HCPOA documents incorporated into the electronic medical records (EMR) of patients undergoing elective surgery at four healthcare institutions. A secondary aim is to examine for correlations between HCPOA document implementation and demographic and preoperative clinical predictors. Methods: A retrospective chart review was performed in 2012 on 500 consecutive adult patients undergoing elective surgery that required general anesthesia at four medical centers. A descriptive analysis and multivariate logistic regression analysis were performed to examine for associations between HCPOA implementation and hospital site, age, gender, ASA score, marital status, body mass index, insurance type, and zip code. Results: Of 1723 charts reviewed, only 382 had a HCPOA document implemented within the EMR at the time of surgery with significant variance between hospital sites. Female sex, a widowed marital status, and an ASA score greater than 2 were significantly associated with having a HCPOA implemented in the EMR, while BMI, insurance type, and socioeconomic status based on zip code did not significantly correlate with the rate of HCPOA documentation. Conclusions: Less than a quarter (22.2%) of patients undergoing elective surgery requiring general anesthesia had a HCPOA document appropriately identified despite the known morbidity and mortality risks. The mere presence of EMR systems, palliative care consultation teams, and preoperative care teams are likely insufficient in ensuring appropriate surrogate documentation prior to elective surgery.

Opioid Induced Neurotoxicity in a Patient With Cancer Related Pain (758)

Fostering Collaboration Between Hospital and Community Pediatric Palliative Care Programs (757) Kathie Kobler, MS APN PCNS-BC CHPPN, Advocate Lutheran General Hospital, Advocate Lutheran General Children’s Hospital, Park Ridge, IL. Henry Mangurten, MD, Hospice and Palliative Care of Northeastern Illinois, Park Ridge, IL. Carrie Alani, RN MA, Hospice and Palliative Care of Northeastern Illinois-Hope’s Friends, Barrington, IL.

Nonopioid Antitussives #200

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