Ethical Debate.....please help : (

[bloves5]

We are having an ethical debate in our LPN class and the scenario we have is kind of hard to come points for. Here is the scenario:

You work in a rural ER and a storm just came through the area. You have received 3 critical care patients within a couple of minutes. The first patient that arrived is a 60 year old female that is having difficult breathing. She appears to have chest trauma and needs an IV, 02, x-ray, lab testing, and probable chest tube placed in order to survive. The second patient is a child that is brought in is having an asthma attack. The third patient arrives and the squad is performing CPR. This patient has been down for about 8 minutes. There are only 2 of you working. You have called the on-call nurse, but she will not be in for another 30 minutes. You have also called the MD, who states he will be there within 20 minutes. How will you handle this situation?

We are for pro: Triage patient (Starting with patient #3, #1 and then #2)

The other team are con: Triage patient (Look at limited resources and forget about #3, try to save #1 and #2)

[Jory, MSN, APRN, CNM]

We are having an ethical debate in our LPN class and the scenario we have is kind of hard to come points for. Here is the scenario:

You work in a rural ER and a storm just came through the area. You have received 3 critical care patients within a couple of minutes. The first patient that arrived is a 60 year old female that is having difficult breathing. She appears to have chest trauma and needs an IV, 02, x-ray, lab testing, and probable chest tube placed in order to survive. The second patient is a child that is brought in is having an asthma attack. The third patient arrives and the squad is performing CPR. This patient has been down for about 8 minutes. There are only 2 of you working. You have called the on-call nurse, but she will not be in for another 30 minutes. You have also called the MD, who states he will be there within 20 minutes. How will you handle this situation?

We are for pro: Triage patient (Starting with patient #3, #1 and then #2)

The other team are con: Triage patient (Look at limited resources and forget about #3, try to save #1 and #2)

Not an ethical issue...it's a critical thinking issue. My answer would be different:

1. CPR patient has been down 8 minutes and has a crew working on them...let them continue. Chances of recovery are slim to none.

2. The child is in the MIDDLE of an astha attack...the child cannot breathe without medicinal intervention and O2 support...this is your PRIORITY patient. The question doesn't tell you how long it has been going on, so assume it's acute, therefore, life threatening.

3. The elderly woman is having difficulty breathing, but she IS BREATHING...of the three, she is your bottom priority. You don't base your treatment in triage on what might or might not happen...you base your treatment on what situation you have now.

[LadyFree28, BSN, LPN, RN]

Not an ethical issue...it's a critical thinking issue. My answer would be different:

1. CPR patient has been down 8 minutes and has a crew working on them...let them continue. Chances of recovery are slim to none.

2. The child is in the MIDDLE of an astha attack...the child cannot breathe without medicinal intervention and O2 support...this is your PRIORITY patient. The question doesn't tell you how long it has been going on, so assume it's acute, therefore, life threatening.

3. The elderly woman is having difficulty breathing, but she IS BREATHING...of the three, she is your bottom priority. You don't base your treatment in triage on what might or might not happen...you base your treatment on what situation you have now.

^This...

Jory basically said what I was going to post.

This is a disaster priority.

I didn't see an ethical debate...nice try though!

[NicuGal, MSN, RN]

What Jory said. When I did my Red Cross Disaster course the CPR one would have been black tagged and then you would treat the child who could go into arrest faster than the other lady then deal with the chest injury.

[bopeep82]

I'm not a nurse yet (starting in the fall), but I am a wildlife rehabilitator. As far as I understand Triage, it's treating those who have the highest survival rate over those that do not. Triage is defined as "sorting according to quality". The issue comes into play when humans apply their emotions to the clear cut answer. Stick with the definitions, right?! lol

[LoveNeverDies]

I am in Nursing school. When I think of Triage, I think of the movie I, Robot. Basically a grown man and a 12 year old girl both go in a river during a car accident. A robot (no emotions just statistics) jumps in and can only save one person. He saves the grown man because his lung capacity and so on gives him a better chance of survival and the child. A human dealing with emotion might choose the child, not considering the time under water and the chances of the child being resuscitated.

[Fireman767]

Im gonna throw in my 2 cents here again because i see quite a few people all over the place. The issues i see here is scope of practice and proper triaging. I said the older woman difficulty breathing because the immediate thing to do would be set up oxygen. You dont need to do a full assessment, a rapid assessment is good for situation. The child would require the same thing, however we need more information on the asthma attack.

Scope of practice because we have no doctor present, and no PA or NP either. the nurse is on the way and can help more but the LPN probably has few if not no standing orders. They can not diagnose or do much to actually reverse the problem unless the problem can be reversed by supportive care. The best thing to do would be support the airway and breathing and contact the physician.

In short, go diff breath, asthma attack, then cpr patient and the first two get supportive care, third gets full code workup.