Chronic Obstructive Pulmonary Disease (COPD): Reset the Case

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Let’s reset the case to before Dr. Khang arrived, before the difference of opinion was settled (if not completely resolved), and before Mr. Moua had signed a DNI paper, and Ms. Jones was at lunch.

Mr. Moua became extremely dyspneic and frantic, while he had a prolonged coughing spell. All of a sudden, he started hemorrhaging blood from his mouth, spewing blood onto his chest and all over his sheets. The wife screamed in terror and the son ran out of the room to get help. Several nurses ran into the room, saw his respiratory difficulty, and proceeded to call a code and give assistance.

Ms. Jones tried to tell the whirling mass of people that Mr. Moua didn’t want to be intubated. When they heard that news, they froze, but the wife screamed at them: “Help! Help!” and the son said, “Help my father breathe. Put the tube down if needed. Start the breathing machine now!”
The people responded to his words, and to the frantic energy of other people arriving, and the code proceeded. Ultimately, the anesthesiologist sedated and intubated him before they moved him to Intensive Care Unit for a ventilator.

Questions for Discussion

Questions for Discussion

1. Do you think that Mr. Moua’s interests were best served? Do you think the team should have stopped the code or continued it?

2. How do you think Mr. Moua will feel when he wakes up and finds that he is intubated and on a ventilator? What consequences might there be for his family members and his healthv care providers?

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