Do Not Intubate/Do Not Resuscitate: Treating the Severely Ill or Injured Geriatric Patient in the Emergency Department

摘要

Eighty-five-year-old Hannah is brought to your emergency department by EMS after she tripped over her cat and fell onto a wooden chair. She complains of pain in the left rib area, and "trouble breathing." Although no paradoxical chest movement is noted over the left rib cage, it is noted that the left anterior and lateral" chest has significant bruising and crepitus on palpation. Hannah has decreased breath sounds on the left, seems to be splinting when she breathes, and is using some accessory muscles. Further examination reveals no head, neck, or upper extremity pain. Her left upper abdomen is tender. She has shortening and rotation of the left leg, her pelvis is stable, and color, motion, and sensation (CMS) of the leg is intact. She has no injury to the right side or back. There was no loss of consciousness. Blood pressure is 102/60, heart rate is 98 beats/min, respiratory rate is 32 breaths/min, oxygen saturation is 88% on 2 liters nasal cannula. and her temperature is 97.8degF.