Communication Skills and Ethics Flashcards
What is brain stem death?
Severe and irreversible damage to the brain stem - control breathing and basic functions for life
How is brain stem death confirmed?
Examination by consultant and another senior doctor
2 Separate occasions - test brainstem functions to see if chance of recovery
If no response - patient is dead
Brain stem death and pain?
Body is unable to feel pain when the brainstem died
What should happen after a diagnosis of brainstem death has been made?
- Inform the family
- Allow time to say goodbye and have any religious/spiritual input they would like
- Discuss r.e. organ transplant
DVLA rules for TIA
Group 1 license - no driving for 4 weeks. No need to inform DVLA
Group 2 - 1 year off.
General DVLA rules
Group 1 - normal vehicles
Group 2 - HGV + often taxi’s. Typically always inform DVLA
DVLA rules for Seizures
First/single with normal EEG/MRI
1 = 6 months
2 = 5 years
Medication change
1 = 6 months
2 = 5 years
DVLA rules for ongoing simple partial seizures
1 = 1 year
2 = never
DVLA rules for non simple partial seizures
1 = 1 year
2 = 10 years
DVLA rules for withdrawal of anti-epileptic drug
1 = 6 months
2 = 10 years
DVLA rules - unexplained syncope
Depend on risk
1 - low = 1 month, high = 6 months
2 - low = 3 months, high = 1 year
DVLA rules for narcolepsy if untreated
Never
DVLA rules following craniotomy
Non tumour:
1 = 6 months
2 = 2 years
High grade tumour:
1 = 2 year
2 = never
DVLA rules for MI
ACS - untreated:
1 = 1 month
2 = 6 weeks (recommendation)
Successful PCI
1 = 1 week
2 = 6 weeks
CABG
1 = 4 weeks
2 = 3 months
DVLA rules for Diabetes
Need DVLA assessment - usually provide 1-3 year license
Conditions to think about dangers of flying
DVT
COPD
Diabetes
Counselling r.e. flying for DVT
Advise r.e. general risk reduction - avoid alcohol
- remain mobile
- avoid tight fitting clothes on LL
- compression stockings
Consider Aspirin - polycythaemia
Consider LMWH - malignancy, personal or family Hx VTE, recent major surgery
Counselling r.e. COPD for flying
If sats >95% on A at rest and pt. can go up flight of stairs or walk 50m without becoming overtly SOB - no issues
If less - consider resp assessment for supplemental in-flight O2
- ABG
- Hypoxic challenges
Flight counselling for diabetes
If on insulin, need to carry with them.
Insulin shouldn’t be in hold as it can freeze
Carry something sugary
Dose adjust:
- reduce if flying east (shorter day)
- increase if flying west (longer day)
Types of consent forms
1 - patient can consent themselves
3 - optional form for consenting patients which doesn’t involve impairment of consciousness
4 - lack capacity
Key components regarding genetic testing
How test is performed
Allow time between discussion and making decision
Receive results in person
Discuss alternatives
Benefits
- early tx, prevention, screening
- poss. preimplantation genetic testing
Negative effects
- Life insurance policies + mortgage
- Implications of family members
Risk of inconclusive test
Issues with penetrance and effects of mutation
- may not necessarily get the disease
Possible genetic conditions that may be tested
Huntington’s
Familial breast cancer
ADPKD, HNPCC etc.
Key things to be aware of with Huntington’s in regards to genetic counselling
If affected parent, 50% chance they will have the mutation
If have mutation, will develop disease
Anticipation - develop symptoms earlier
No cure or treatments that can prevent disease
Benefits :
- negative test = peace of mind
- option for pre-implantation genetic testing for future pregnancies
Can’t say how disease will affect them
Things to be aware of with breast cancer screening for a genetic counselling station
BRCA 1 - 80% breast, 40% ovarian. BRCA 2 - 45%
Negative test does not mean they will never get breast cancer.
Positive test doesn’t necessarily mean they will get breast cancer.
Can have treatment to prevent breast cancer
Advise r.e. reducing risk:
- lose weight
- reduce alcohol
- attend screening
- Increased risk breast cancer with OCP. Reduced risk ovarian cancer
- increased risk of breast cancer with progesterone containing HRT
