Ethical Debate.....please help : (

morte, LPN, LVN · Jun 10, 2013

don't think my answer is going to help you.....the squad wouldn't be leaving in a big hurry....

chare · Jun 10, 2013

I don't see an ethical issue in the scenario you describe. However, this is a good mass casualty incident scenario. If you have not done so, you might review mass casualty triage. The START triage method is one that is widely used.

Specifically, what question are you debating, what response has your group developed, and why?

suppaduppaCNA · Jun 10, 2013

Yes, I do not see an ethical dilemma here either. It's all about critical thinking...:)

snuggles49 · Jun 10, 2013

The ethical dilemma comes into play when you start choosing what patient you will treat first...the "con team" has to support their decision to let the pt who is getting CPR be last on the list.... this is a hypthetical situtation which does stimulate thier critical thinking skills...as we all know if this were a real situtation you would keep the "squad" doing CPR one of the nurses available would deal with PT #1 and the other #2, a call would be paged to the supervisor and calls for assisstance from other floors but the assignment is about the ethical dilemma of choosing one patient over the other...good luck in your assignment

nurseprnRN, BSN, RN · Jun 10, 2013

This is not an ethical issue, as ethics are defined. If your faculty wants you to base your choice on evidence-based research, there are a number of scales, references, and other resources to follow up with at Triage - Wikipedia, the free encyclopedia. read the entire page, check some of the references, and see what works for you.

If they expect you to justify your choices on emotion or your own gut impulse, then this is a public-speaking or persuasive writing exercise, and your job is to do the best job you can at that.

Esme12, ASN, BSN, RN · Jun 11, 2013

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)

The problem is there is no problem....8 min down time CPR in progress. They are DOA.

The ethical debate is if you treat the CPR in progress and the lady with diff breathing and chest trauma also codes and necessarily dies because something was missed while the person who is essentially DOA was being coded. Mass causality situations have hard decisions but you also look at the survivability of the current injury. Traumatic arrests just don't succeed.

classicdame, MSN, EdD · Jun 11, 2013

I guess the ethics comes in when you consider whom to treat first. If there is no MD around (what was implied!!!!), then I would let the EMS continue doing their thing, then have one nurse on each of the other patients. Think about CPR. The first thing is to get help. Surely there is someone in the hospital who can assist. If not, you can only do what you can do and pt. #1 may not get the care as everything they need has to be ordered by an MD/NP/PA and is out of your scope of practice. I would also take the ER sign off the door as this is not one!

sanwil · Jun 11, 2013

#1 first, survival depends on immediate treatment. #2 second, child ( age unknown ) w/ difficulty breathing. # 3 is not to be forgotten, however 8 min. down may have brain damage, & quality of life should be considered against survival. Difficult decision.

**NICU Guy, BSN, RN** · Jun 11, 2013

this isn't a debate. A debate is to get the audience to see each sides point of view as the correct one. Yours can not win. The patient that is in cardiac arrest has an unknown time frame. Potentially 20 minutes until MD arrives and pronounces the patient dead. In the mean time your other 2 patients are also dead.

Of course this is a hypothetical hospital in which there is nobody else in the hospital except these 2 nurses. In the real world you would pull respiratory, other nurses, PCAs, and the EMS crew to help out. In a triage situation, you care for the living patients only.

Fireman767 · Jun 12, 2013

Few things, People must understand that once EMS has gotten the patient into the ER and patient is in a trauma room, a handover of care should be done within the following minutes. In the event of an emergency, such as this storm mentioned EMS resources are allocated on a short term trip to the ER, that means turf them and sign because of their precious limited aspects in the field and need during such an event. Understand that yes the patient is coding, but resuming CPR without starting ACLS or more advanced care is an issue in itself. You can anticipate EMS helping for a few minutes, but there is a strict time during incidents in which EMS has windows of time they spend on scene of an incident (in a storm just like trauma, it's 10 minutes), as well as at a hospital (depending on the incident, nature of the call, paperwork (usually after 15 minutes radio dispatch starts paging you, and as volume of calls increases compared to time spent at the hospital, pressure to respond sets in). This is during an MCI, during standard operations it's much more relaxed.

Following ABCs the patient with difficulty breathing should be taken care of because she can develop into a worse condition quickly or cardiovascular involvement may occur. This patient would be my main priority or the priority i designate to a fellow nurse.

The child should also be taken care of, but we must know how long the asthma attack has been occurring. it could have just started or it could have been existing for hours.

Following SMART triage, the patient coding is a low priority because they require more materials and deeper assessment than the "60 seconds" that should be spent with each patient before moving onto the next. The patient who is difficulty breathing is the level that receives the most care because they can effectively be treated early and not progress into the stage of triage as the patient coding. The child is a lower priority, although a priority none-the-less.

The only ethical debate i see is why there are only two LPNs in a rural ER and no MDs, RNs, NPs, PAs, etc. That sounds like a dilemma to me since there isn't as much autonomy as an RN, NP, PA, or MD.

The other team won, the fact that thought of working the CPR patient when you can save two lives quicker before they progress down the emergency levels is the issue. and if you had ignored patient #1 and #2 and they progressed, expect the MD or RN coming on to be quick irritated, they don't like more work when short steps could have been taken to prevent progression.

phuretrotr · Jun 14, 2013

Minus the CPR patient, wouldn't the asthma kid come before the breathing elderly lady? Just wondering since asthma is technically Airway because of the constriction of the bronchioles, wouldn't that come first than the lady that has trouble Breathing?

Don't know if that's right, just a thought...