ChoiceHub
Sign in
An 81-year-old man had a large left middle cerebral artery infarct ten days ago. He cannot swallow safely and can neither understand nor communicate a decision. The team proposes a percutaneous endoscopic gastrostomy tube on Thursday. Six years ago he completed an advance health directive refusing cardiopulmonary resuscitation and mechanical ventilation; it says nothing about feeding. He has no enduring guardian. His wife, from whom he separated eleven years ago and whom he has not seen since, telephones the ward asking to be consulted. His daughter has lived in his house for six years and visits daily. Which one of the following should the team approach for the treatment decision?
Shared by Mornienmiddle twist

Keep going — a set of ten like this one, one at a time.

Practise more

More from Acute Care

See all

A 7-year-old boy is ready to leave a Perth emergency department six hours after a moderate asthma flare-up. He has had salbutamol by spacer and a first dose of…

Clinical rotations · middle twist

A 78-year-old woman is being discharged after an admission with melaena. She takes apixaban for atrial fibrillation. Gastroscopy showed a bleeding duodenal ulce…

Clinical rotations · middle twist

You are the intern on a Perth surgical ward. Overnight a 74-year-old woman received ten times the intended dose of insulin because of a prescribing error you ma…

Pre-internship · middle twist

A 62-year-old Aboriginal woman from a remote Kimberley community is admitted to a Broome hospital with small bowel obstruction and listed for laparotomy on tomo…

Pre-internship · middle twist

You are the intern in a Perth emergency department at 0200. Paramedics have just handed over a 78-year-old woman brought in after a fall at home, using the stru…

Clinical rotations · common