NESB urgent surgical consent

Question 1

A 68 year old Russian man, who does not speak English, becomes hypotensive and anaemic 12 hours after abdominal surgery and urgently needs to return to theatre. How would you obtain consent?

Answer 1

Introductory
In this urgent surgical scenario, I would be prioritising my management by;
- administering appropriate stabilising and temporising supportive measures until consent can be obtained
- if it is not possible to obtain appropriate informed consent in a timely fashion, then the operation should not be delayed under the principle of duty of care.

Question 2

NESB consent - Assessment

Answer 2

Assessment
- would implement appropriate temporising measures to keep patient stable before consent can be made; fluids, blood replacement, etc

Question 3

NESB consent - Consent process

Answer 3

Consent process hierarchy

• Translator services at the hospital
• Translator phone services hotline
• Next of kin
• Substitute consent, act in patients best wishes and overriding duty of care and take to theatres anyway

Consent process to go through with patient

• capacity (4 components to capacity, is specific to each medical decision)
• indications
• explain the Procedure (emergency laparotomy +/- proceed where surgeons do whatever else is necessary for the patient)
• complications
• risks/benefits
• alternatives
• informed consent

Question 4

NESB consent - other considerations

Answer 4

Consideration

• patient notes for any NFR, ACD, enduring guardians.
• would not like to utilise NOK for consent given the conflict of interest.