AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 4

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Case 4.2: Practicing a Procedure on the Newly Deceased—Mrs. Milos's Pericardiocentesis

Case Presentation

Maia Desai is a third-year emergency medicine resident in a large urban teaching hospital. Dr. Desai has 2 fourth-year medical students under her supervision. Lydia Santos and Carl Meyers have a few days remaining in their month-long rotation. Dr. Desai, a conscientious clinician and teacher, is pleased with Lydia's and Carl's performances during their rotation. Each has gained a good knowledge base and is acquiring skills in suturing lacerations, wound debridement, and assisting in advanced CPR codes.

On the students' last day in the ER rotation, Mrs. Milos, a 76-year-old woman with a history of two previous MIs, is brought in by ambulance from a local skilled nursing facility. Mrs. Milos was already intubated when the EMTs wheeled her into the ER. She suffered cardiac arrest en route, and the ambulance crew administered shock and pharmacologic treatment while continuing chest compressions. Mrs. Milos's son arrived by car soon after Mrs. Milos was wheeled into a treatment room. He was kept away from the resuscitation attempts and awaits news.

Despite all attempts to resuscitate Mrs. Milos, Dr. Desai calls off the code approximately 20 minutes after her arrival in the ER. After calling off the code, Dr. Desai realizes there's a chance that some pericardial blood has collected. This is an opportunity for Lydia or Carl to do a pericardiocentesis. Lydia and Carl recently practiced the techniques of pericardiocentsis on anatomical mannequins. Now they can take the next step in the learning process.

What should Dr. Desai do? (select an option)

A.   Tell Lydia or Carl to attempt a pericardiocentesis.
B.   Inform Mrs. Milos' son of her death and ask for consent to have a medical student attempt a pericardiocentesis.
C.   Inform Mrs. Milos' son of her death and choose not to pursue this training opportunity.
D.   Tell Lydia or Carl to inform Mrs. Milos' son of her death and ask for consent to attempt a pericardiocentesis.
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