Informed consent

Informed consent US Medical PG Question 1: A 79-year-old male presents to your office for his annual flu shot. On physical exam you note several linear bruises on his back. Upon further questioning he denies abuse from his daughter and son-in-law, who live in the same house. The patient states he does not want this information shared with anyone. What is the most appropriate next step, paired with its justification?

• A. Breach patient confidentiality, as this patient's care should be discussed with the daughter as she is his primary caregiver
• B. See the patient back in 2 weeks and assess whether the patient's condition has improved, as his condition is not severe
• C. Do not break patient confidentiality, as elder abuse reporting is not mandatory
• D. Do not break patient confidentiality, as this would potentially worsen the situation
• E. Breach patient confidentiality, as this patient is a potential victim of elder abuse and reporting is mandated in most states (Correct Answer)

Informed consent Explanation: ***Breach patient confidentiality, as this patient is a potential victim of elder abuse and reporting is mandated in most states*** - As a physician, there is a **legal and ethical obligation** to report suspected elder abuse in most US states, even when the patient denies it and requests confidentiality. - Physicians are typically **mandatory reporters** under state law, and must report to Adult Protective Services or law enforcement when elder abuse is suspected. - The patient's safety and legal requirements outweigh the right to confidentiality in jurisdictions with mandatory reporting laws. *Breach patient confidentiality, as this patient's care should be discussed with the daughter as she is his primary caregiver* - Breaching confidentiality to discuss this with the daughter would be inappropriate, especially since the daughter and son-in-law are the **suspected abusers**. - Discussing with the primary caregiver is only appropriate if the patient has given **explicit consent** and there are no suspicions of abuse from that caregiver. *See the patient back in 2 weeks and assess whether the patient's condition has improved, as his condition is not severe* - This option is inappropriate because it delays intervention in a potentially **dangerous situation**. - Suspected abuse warrants **immediate action** to ensure the patient's safety, regardless of the perceived severity of current injuries. *Do not break patient confidentiality, as elder abuse reporting is not mandatory* - In **most states**, physicians have **mandatory reporting laws** for elder abuse, making this statement generally incorrect. - Physicians are typically considered "mandated reporters" and are legally required to report suspected abuse to the appropriate authorities in their jurisdiction. *Do not break patient confidentiality, as this would potentially worsen the situation* - While this is a valid concern in some situations, the **primary responsibility** of a physician is to protect vulnerable patients from harm. - Reporting suspected abuse initiates protective measures and is legally required in most states, as the potential benefit of intervention outweighs the risk of worsening the situation.

Informed consent US Medical PG Question 2: A 76-year-old man is brought to the hospital after having a stroke. Head CT is done in the emergency department and shows intracranial hemorrhage. Upon arrival to the ED he is verbally non-responsive and withdraws only to pain. He does not open his eyes. He is transferred to the medical ICU for further management and intubated for airway protection. During his second day in the ICU, his blood pressure is measured as 91/54 mmHg and pulse is 120/min. He is given fluids and antibiotics, but he progresses to renal failure and his mental status deteriorates. The physicians in the ICU ask the patient’s family what his wishes are for end-of-life care. His wife tells the team that she is durable power of attorney for the patient and provides appropriate documentation. She mentions that he did not have a living will, but she believes that he would want care withdrawn in this situation, and therefore asks the team to withdraw care at this point. The patient’s daughter vehemently disagrees and believes it is in the best interest of her father, the patient, to continue all care. Based on this information, what is the best course of action for the physician team?

• A. Call other family members and consult them for their opinions
• B. Listen to the patient’s daughter’s wishes and continue all care
• C. Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated
• D. Listen to the patient’s wife’s wishes and withdraw care (Correct Answer)
• E. Consult the hospital ethics committee and continue all care until a decision is reached

Informed consent Explanation: ***Listen to the patient’s wife’s wishes and withdraw care*** - The **durable power of attorney for healthcare** legally designates the wife as the patient's surrogate decision-maker when the patient lacks capacity, overriding other family opinions. - In the absence of a living will, the **surrogate's interpretation of the patient's best interests** and previously expressed wishes is legally and ethically binding. *Call other family members and consult them for their opinions* - While involving family is good practice in general, the presence of a **legally appointed durable power of attorney** means that other family members' opinions do not supersede the designated surrogate's decisions. - Consulting other family members could **create more conflict and delay** crucial decisions, as the wife holds the legal authority. *Listen to the patient’s daughter’s wishes and continue all care* - The daughter's wishes, while understandable, **do not hold legal authority** over the decisions of the legally appointed durable power of attorney. - Disregarding the wife's authority would be a **breach of ethical and legal obligations** in patient care. *Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated* - A compromise that goes against the legal surrogate's explicitly stated decision (to withdraw all care) is **ethically problematic and legally unsound**. - Healthcare decisions should be based on the patient's best interest as interpreted by the **authorized surrogate**, not on attempting to please all family members. *Consult the hospital ethics committee and continue all care until a decision is reached* - While an ethics committee consult is appropriate if there's **disagreement over the interpretation of the patient's wishes** *among legally designated surrogates* or concerns about the surrogate's decision-making capacity, it's not the first step when a clear legal surrogate with documentation is present and makes a decision. - Continuing all care against the wishes of the **legal proxy** would be contrary to patient autonomy and the principles of substituted judgment.

Informed consent US Medical PG Question 3: A 29-year-old man is admitted to the emergency department following a motorcycle accident. The patient is severely injured and requires life support after splenectomy and evacuation of a subdural hematoma. Past medical history is unremarkable. The patient’s family members, including wife, parents, siblings, and grandparents, are informed about the patient’s condition. The patient has no living will and there is no durable power of attorney. The patient must be put in an induced coma for an undetermined period of time. Which of the following is responsible for making medical decisions for the incapacitated patient?

• A. The spouse (Correct Answer)
• B. An older sibling
• C. Physician
• D. Legal guardian
• E. The parents

Informed consent Explanation: ***The spouse*** - In the absence of a **living will** or **durable power of attorney**, the law typically designates the **spouse** as the primary decision-maker for an incapacitated patient. - This hierarchy is established to ensure decisions are made by the individual most intimately connected and presumed to understand the patient's wishes. *An older sibling* - Siblings are generally further down the **hierarchy of surrogate decision-makers** than a spouse or parents. - They would typically only be considered if higher-priority family members are unavailable or unwilling to make decisions. *Physician* - The physician's role is to provide medical care and guidance, not to make medical decisions for an incapacitated patient when family surrogates are available. - Physicians only make decisions in **emergency situations** when no surrogate is immediately available and treatment is immediately necessary to save the patient's life or prevent serious harm. *Legal guardian* - A legal guardian is usually appointed by a **court** when there is no appropriate family member available or when there is a dispute among family members. - In this scenario, with a spouse and other close family members present, a legal guardian would not be the first choice. *The parents* - While parents are close family members, they are typically considered **secondary to the spouse** in the hierarchy of surrogate decision-makers for an adult patient. - They would usually only be the decision-makers if the patient were unmarried or the spouse were unavailable.

Informed consent US Medical PG Question 4: A 19-year-old man presents to an orthopedic surgeon to discuss repair of his torn anterior cruciate ligament. He suffered the injury during a college basketball game 1 week ago and has been using a knee immobilizer since the accident. His past medical history is significant for an emergency appendectomy when he was 12 years of age. At that time, he said that he never wanted to have surgery again. At this visit, the physician explains the procedure to him in detail including potential risks and complications. The patient acknowledges and communicates his understanding of both the diagnosis as well as the surgery and decides to proceed with the surgery in 3 weeks. Afterward, he signs a form giving consent for the operation. Which of the following statements is true about this patient?

• A. He cannot provide consent because he lacks capacity
• B. He has the right to revoke his consent at any time (Correct Answer)
• C. His parents also need to give consent to this operation
• D. He did not need to provide consent for this procedure since it is obviously beneficial
• E. His consent is invalid because his decision is not stable over time

Informed consent Explanation: ***He has the right to revoke his consent at any time*** - **Informed consent** for medical procedures is an ongoing process, and a patient retains the right to **withdraw consent** at any point, even after initially signing the consent form. - This right is a fundamental aspect of patient autonomy and ensures that medical interventions are only performed with a patient's current and willing agreement. *He cannot provide consent because he lacks capacity* - The patient is 19 years old, which in most jurisdictions (including the US where the age of majority is typically 18) means he is considered an **adult** and legally capable of providing his own consent. - The scenario explicitly states he "communicates his understanding of both the diagnosis as well as the surgery," indicating he possesses the **mental capacity** to make an informed decision. *His parents also need to give consent to this operation* - As a 19-year-old, the patient has reached the **age of majority** and is legally entitled to make his own medical decisions, including consenting to surgery. - Parental consent is generally required for minors (individuals under the age of majority), but not for adults like this patient. *He did not need to provide consent for this procedure since it is obviously beneficial* - Even for procedures that are clearly **beneficial**, informed consent is ethically and legally mandatory to uphold **patient autonomy** and ensure respect for individual rights. - The concept of "obviously beneficial" does not negate the requirement for a patient's explicit agreement to a medical intervention. *His consent is invalid because his decision is not stable over time* - While the patient might have initially hated surgery at age 12, his current decision at age 19 to proceed with the ACL repair is based on current information and his mature understanding. - The fact that his previous aversion to surgery has changed does not invalidate his current, well-informed decision; it simply indicates a change in perspective based on new circumstances and greater maturity.

Informed consent US Medical PG Question 5: A psychiatrist receives a call from a patient who expresses thoughts of harming his ex-girlfriend. The patient describes a detailed plan to attack her at her workplace. Which of the following represents the psychiatrist's most appropriate legal obligation?

• A. Warn the ex-girlfriend and notify law enforcement (Correct Answer)
• B. Only notify the patient's family
• C. Warn only law enforcement
• D. Maintain patient confidentiality

Informed consent Explanation: ***Warn the ex-girlfriend and notify law enforcement*** - This scenario directly triggers the **"duty to warn"** and **"duty to protect"** principles, primarily stemming from the **Tarasoff v. Regents of the University of California** case. - The psychiatrist has a legal obligation to take reasonable steps to protect the identifiable victim, which includes directly warning the intended victim and informing law enforcement. *Only notify the patient's family* - Notifying the patient's family alone does not fulfill the **legal obligation to protect** an identifiable third party from a serious threat of harm. - While family involvement might be part of a comprehensive safety plan, it is insufficient as the sole action in this critical situation. *Warn only law enforcement* - While notifying law enforcement is a crucial step, the **Tarasoff duty** specifically mandates warning the **intended victim** directly (or those who can reasonably be expected to notify the victim). - Relying solely on law enforcement might not ensure the immediate safety of the ex-girlfriend, especially if there's a delay in their response or ability to locate her. *Maintain patient confidentiality* - Patient confidentiality is a cornerstone of psychiatric practice, but it is **not absolute** when there is a serious and imminent threat of harm to an identifiable individual. - The **duty to protect** a potential victim *outweighs* the duty to maintain confidentiality in such extreme circumstances.

Informed consent US Medical PG Question 6: A 32-year-old male asks his physician for information regarding a vasectomy. On further questioning, you learn that he and his wife have just had their second child and he asserts that they no longer wish to have additional pregnancies. You ask him if he has discussed a vasectomy with his wife to which he replies, "Well, not yet, but I'm sure she'll agree." What is the next appropriate step prior to scheduling the patient's vasectomy?

• A. Insist that the patient first discuss this procedure with his wife
• B. Telephone the patient's wife to inform her of the plan
• C. Refuse to perform the vasectomy
• D. Explain the risks and benefits of the procedure and request signed consent from the patient and his wife
• E. Explain the risks and benefits of the procedure and request signed consent from the patient (Correct Answer)

Informed consent Explanation: ***Explain the risks and benefits of the procedure and request signed consent from the patient*** - A patient has the **right to make autonomous decisions** about their own medical care, including reproductive choices, regardless of their marital status or spousal approval. - The physician's role is to ensure the patient is fully informed and provides **voluntary, uncoerced consent** after understanding the risks, benefits, and alternatives of the procedure. *Insist that the patient first discuss this procedure with his wife* - This option would be a **violation of patient autonomy** and confidentiality, as a married person has the right to make independent medical decisions. - Requiring spousal consent for a procedure performed solely on one individual is not ethically or legally mandated and could be considered discriminatory. *Telephone the patient's wife to inform her of the plan* - This action would be a **breach of patient confidentiality**, as the patient's medical information, including his intent to have a vasectomy, cannot be shared with a third party, even a spouse, without explicit permission. - Informing the wife without the husband's consent also undermines the patient's autonomy and right to privacy regarding his healthcare decisions. *Refuse to perform the vasectomy* - Refusing to perform the procedure simply because the patient has not discussed it with his wife would be **unethical and inconsistent with medical professionalism**, assuming the patient is competent and fully informed. - A physician should not deny medically appropriate care based on a patient's marital dynamics or the presumed wishes of a spouse, as long as the patient's consent is valid. *Explain the risks and benefits of the procedure and request signed consent from the patient and his wife* - While it is advisable for a patient to discuss major life decisions with their spouse, requiring **spousal consent for a patient's own medical procedure** is not legally or ethically mandated for competent adults. - Obtaining consent from both individuals is typically reserved for procedures affecting both parties directly or for those involving a surrogate decision-maker, not for an autonomous adult's personal medical choice.

Informed consent US Medical PG Question 7: A 28-year-old woman is brought to the emergency department after being resuscitated in the field. Her husband is with her and recalls seeing pills beside her when he was in the bathroom. He reveals she has a past medical history of depression and was recently given a prescription for smoking cessation. On physical exam, you notice a right-sided scalp hematoma and a deep laceration to her tongue. She has a poor EEG waveform indicating limited to no cerebral blood flow and failed both her apnea test and reflexes. She is found to be in a persistent vegetative state, and the health care team starts to initiate the end of life discussion. The husband states that the patient had no advance directives other than to have told her husband she did not want to be kept alive with machines. The parents want all heroic measures to be taken. Which of the following is the most accurate statement with regards to this situation?

• A. The physician may be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.
• B. The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.
• C. The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf. (Correct Answer)
• D. An ethics committee must be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.
• E. A court-appointed guardian may be appointed as the patient's health care surrogate and may make end-of-life decisions on her behalf.

Informed consent Explanation: ***The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.*** - The **hierarchy for healthcare surrogates** typically prioritizes the spouse over parents when there is no advance directive. The husband's recollection of the patient's wishes, although not a formal advance directive, is also relevant. - State laws generally designate the **spouse as the primary default decision-maker** for incapacitated patients, followed by adult children, parents, and then adult siblings. *The physician may be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.* - A physician's role is to provide medical care and guidance, not to act as a **healthcare surrogate** due to potential conflicts of interest. - Appointing the treating physician as a surrogate undermines the principles of **patient autonomy** and impartial decision-making. *The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.* - While parents are part of the surrogate hierarchy, they are generally ranked below the **spouse** in most jurisdictions. - The parents' desire for "heroic measures" directly conflicts with the patient's stated wish to her husband, potentially leading to decisions not in the patient's best interest or previously expressed values. *An ethics committee must be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.* - An ethics committee's role is to provide **guidance and recommendations** in complex cases, mediate disputes, and ensure ethical principles are upheld, not to act as the primary healthcare surrogate. - A functional healthcare surrogate takes precedence over an ethics committee in making direct treatment decisions. *A court-appointed guardian may be appointed as the patient's health care surrogate and may make end-of-life decisions on her behalf.* - A court-appointed guardian is typically sought only if there is **no clear or willing surrogate** from the established hierarchy, or if there is a dispute among family members that cannot be resolved. - In this scenario, the husband is the legally recognized next of kin and surrogate by default, making court intervention unnecessary at this stage.

Informed consent US Medical PG Question 8: A 32-year-old woman is brought to the emergency department by her husband because of an episode of hematemesis 2 hours ago. She has had dyspepsia for 2 years. Her medications include occasional ibuprofen for headaches. After initial stabilization, the risks and benefits of upper endoscopy and alternative treatments, including no therapy, are explained thoroughly. She shows a good understanding of her condition and an appreciation of endoscopic treatment and its complications. She decides that she wants to have an endoscopy to find the source of bleeding and appropriately manage the ulcer. Her medical records show advance directives that she signed 3 years ago; her sister, who is a nurse, has a durable power of attorney. Regarding obtaining informed consent, which of the following is the most accurate conclusion for providing endoscopic treatment for this patient?

• A. There are reasons to believe that she may not have decision-making capacity
• B. Endoscopic treatment may be performed without further action
• C. Her sister must sign the consent form
• D. Documentation of her decision prior to treatment is required (Correct Answer)
• E. Her decision to have an endoscopy is not voluntary

Informed consent Explanation: **Documentation of her decision prior to treatment is required** - The patient has been fully informed, understands her condition, and has expressed a clear desire for the procedure, demonstrating **decision-making capacity**. - To ensure ethical and legal compliance, her **informed consent** must be accurately documented in her medical record before any invasive treatment, including endoscopy, is performed. *There are reasons to believe that she may not have decision-making capacity* - The patient has clearly demonstrated **understanding of her condition, treatment options, and potential complications**, which indicates preserved decision-making capacity. - Despite the acute medical situation, her ability to articulate her preference after a thorough discussion confirms her competence for informed consent. *Endoscopic treatment may be performed without further action* - While the patient has consented verbally, this does not negate the need for proper **documentation of informed consent** before initiating the procedure. - Legally and ethically, a verbal agreement alone is insufficient; a signed consent form or detailed chart note confirming her understanding and decision is essential. *Her sister must sign the consent form* - Her sister, holding a **durable power of attorney**, would only be authorized to make medical decisions if the patient were deemed to lack **decision-making capacity**. - Since the patient clearly demonstrates the ability to make her own medical decisions, her sister's consent is not required and would override the patient's autonomy. *Her decision to have an endoscopy is not voluntary* - The scenario explicitly states that the risks and benefits were **thoroughly explained**, and she shows a "good understanding" and "appreciation of endoscopic treatment." - Her decision to "want to have an endoscopy" despite knowing the alternatives suggests a **voluntary and informed choice**, not coercion.

Informed consent US Medical PG Question 9: A 68-year-old man comes to the emergency department because of sudden onset abdominal pain for 6 hours. On a 10-point scale, he rates the pain as a 8 to 9. The abdominal pain is worst in the right upper quadrant. He has atrial fibrillation and hyperlipidemia. His temperature is 38.7° C (101.7°F), pulse is 110/min, and blood pressure is 146/86 mm Hg. The patient appears acutely ill. Physical examination shows a distended abdomen and tenderness to palpation in all quadrants with guarding, but no rebound. Murphy's sign is positive. Right upper quadrant ultrasound shows thickening of the gallbladder wall, sludging in the gallbladder, and pericolic fat stranding. He is admitted for acute cholecystitis and grants permission for cholecystectomy. His wife is his healthcare power of attorney (POA), but she is out of town on a business trip. He is accompanied today by his brother. After induction and anesthesia, the surgeon removes the gallbladder but also finds a portion of the small intestine is necrotic due to a large thromboembolism occluding a branch of the superior mesenteric artery. The treatment is additional surgery with small bowel resection and thromboendarterectomy. Which of the following is the most appropriate next step in management?

• A. Decrease the patient's sedation until he is able to give consent
• B. Contact the patient's healthcare POA to consent
• C. Proceed with additional surgery without obtaining consent (Correct Answer)
• D. Ask the patient's brother in the waiting room to consent
• E. Close the patient and obtain re-consent for a second operation

Informed consent Explanation: ***Proceed with additional surgery without obtaining consent*** - In an **emergency situation** where immediate intervention is required to save a patient's life or prevent serious harm, and the patient **lacks capacity** to consent, explicit consent for additional necessary procedures is not required. The surgeon can proceed based on the principle of **implied consent** in emergencies. - The discovery of **necrotic small bowel due to thromboembolism** is a life-threatening condition requiring urgent surgical intervention in an already sedated patient, making it an emergency. *Decrease the patient's sedation until he is able to give consent* - Decreasing sedation to obtain consent in this critical situation would cause a **dangerous delay** in treating a life-threatening condition (bowel necrosis) and could lead to worsening outcomes or death. - The patient is **acutely ill** and likely in a state where he cannot grasp information and make decisions, even with reduced sedation, thus true informed consent would be difficult to obtain quickly. *Contact the patient's healthcare POA to consent* - Contacting the POA who is out of town would introduce **significant and potentially fatal delays** in treating a rapidly progressing, life-threatening condition. - While POAs are crucial for non-emergent decision-making, the **principle of preserving life** takes precedence in an acute emergency when a delay would cause irreversible harm. *Ask the patient's brother in the waiting room to consent* - The brother is **not the designated healthcare POA** and there is no indication he has legal authority to make medical decisions for the patient. - Relying on a non-POA family member for consent in an emergency, when the patient's legally appointed surrogate is known, is generally **not the appropriate first step** unless no other option exists and the brother can confirm the patient's wishes from prior discussions, which is not stated. *Close the patient and obtain re-consent for a second operation* - Closing the patient and then re-opening for another surgery would expose the patient to **two separate anesthetic events and surgical procedures**, significantly increasing morbidity and mortality risks compared to continuous surgery. - This option would also introduce an **unacceptable delay** in addressing the acute bowel necrosis, which requires immediate intervention.

Informed consent US Medical PG Question 10: A 12-year-old boy is brought to the emergency department after a motor vehicle collision. He was being carpooled to school by an intoxicated driver and was involved in a high velocity head-on collision. The patient is otherwise healthy and has no past medical history. His temperature is 99.2°F (37.3°C), blood pressure is 80/45 mmHg, pulse is 172/min, respirations are 36/min, and oxygen saturation is 100% on room air. A FAST exam demonstrates free fluid in Morrison pouch. The patient’s parents arrive and state that they are Jehovah’s witnesses. They state they will not accept blood products for their son but will allow him to go to the operating room to stop the bleeding. Due to poor understanding and a language barrier, the parents are also refusing IV fluids as they are concerned that this may violate their religion. The child is able to verbalize that he agrees with his parents and does not want any treatment. Which of the following is the best next treatment for this patient?

• A. Observation and monitoring and obtain a translator
• B. IV fluids alone as surgery is too dangerous without blood product stabilization
• C. IV fluids and emergency surgery
• D. IV fluids and vasopressors followed by emergency surgery
• E. Blood products and emergency surgery (Correct Answer)

Informed consent Explanation: ***Blood products and emergency surgery*** - The patient is a **minor** with a **life-threatening injury** (hypotension, tachycardia, free fluid in Morrison's pouch indicating internal bleeding) and requires immediate intervention. In such cases, the state's interest in protecting the life of a child generally **overrides parental religious objections** to life-saving treatment, including blood transfusions. - **Emergency surgery** is necessary to stop the bleeding, and **blood products** are crucial for stabilizing the patient's hemodynamic status and preventing irreversible shock and death, especially given his severe hypotension and tachycardia. - Note: **IV fluids would also be administered** as part of standard trauma resuscitation protocol alongside blood products. The key ethical and medical issue here is the authorization to give **blood products** despite parental refusal, which is legally and ethically justified in life-threatening situations involving minors. *Observation and monitoring and obtain a translator* - This option is inappropriate as the patient is **hemodynamically unstable** and showing signs of severe hemorrhage, requiring immediate, not delayed, intervention. - While a translator is important for communication, obtaining one should happen concurrently with life-saving treatment, not as an initial, sole intervention for an unstable patient. *IV fluids alone as surgery is too dangerous without blood product stabilization* - The patient requires both **IV fluids for resuscitation** and **surgery to definitively stop internal bleeding**; focusing on fluids alone without addressing the source of hemorrhage will not resolve the critical condition. - Delaying surgery because of concerns about blood products is dangerous, as the patient might continue to bleed internally and decompensate further, highlighting the need for both interventions simultaneously. *IV fluids and emergency surgery* - Although IV fluids and emergency surgery are necessary, this patient is in **hemorrhagic shock** and will almost certainly require **blood products** to survive the surgery and subsequent recovery. - This option fails to address the **central ethical dilemma**: whether to override parental religious objections to administer life-saving blood products to a minor. Proceeding with surgery without blood products in this scenario significantly increases the risk of mortality. *IV fluids and vasopressors followed by emergency surgery* - **Vasopressors** are generally used in distributive shock or when fluid resuscitation has failed, and they can worsen organ perfusion in severe hemorrhagic shock by increasing afterload without addressing the volume deficit. - While **IV fluids** and **emergency surgery** are critical, the patient's severe bleeding likely warrants **blood products** in addition to fluids to adequately replace lost volume and improve oxygen-carrying capacity.

Informed consent Flashcard 1 of 6

Question: SVC syndrome can be caused by _____ from indwelling central venous catheters

Answer: thromboemboli

Informed consent Flashcard 2 of 6

Question: Give four common exceptions to informed consent.

Answer: 1 - legally incompetent 2 - implied consent in emergency 3 - patient waiver 4 - therapuetic privilege (disclosure could harm the patient)

Informed consent Flashcard 3 of 6

Question: What are the three procedural requirements for informed consent? (i.e. steps that must be taken, not characteristics of the patient.)

Answer: 1 - discussion of pertinent info 2 - agreement to plan 3 - freedom from coercion

Informed consent Flashcard 4 of 6

Question: Legal exceptions for parental consent include: (1) - _____ treatment (2) - if the minor is legally emancipated

Answer: emergency

Extra Information: Watch associated Bootcamp video [https://app.bootcamp.com/med-school/public-health-sciences/videos/ethics?index=3] https://onlinemeded.org?ref=anki 

Informed consent Flashcard 5 of 6

Question: When presented with a wound, consideration for tetanus vaccination begins with determining whether _____ lifetime doses have been given or not.

Answer: three

Extra Information:  https://onlinemeded.org/spa/pediatrics/vaccinations/acquire?ref=anki 

Informed consent Flashcard 6 of 6

Question: Patients typically get exposed to _____ radiation via nuclear reactor accidents or radiotherapy

Answer: Ionizing