Station 4 Flashcards

Question

What is the Bolam and Bolitho test?

Answer 1

Bolam test: In law a practitioner does not breach standards if a responsible body of similar medical peers supports the practice in question. The montgomery case has changed this and says patients need to be told what a reasonable patient would like to know to make an informed decision. Bolitho test: (1) "The court should not accept a defence argument as being ‘reasonable’, ‘respectable’ or ‘responsible’ without first assessing whether such opinion is susceptible to logical analysis”, and (2) "However, where there is a body of medical opinion which represents itself as ‘reasonable’, ‘respectable’ or ‘responsible’ it will be rare for the court to be able to hold such opinion to be other than represented”.

Answer 2

1. Pre-contemplation- pt sees no problem with behaviour 2. Contemplation- weighing up pros and cons 3. Determenation- to carry on as before or to change 4. Active change 5. Maintenence 6. Lapse/replapse

Answer 3

Living donor organ donation is always non-conditional (can't pay somebody) Careful screening to ensure no harm comes to donor post donation. Work up for donor can potentially reveal new health problems eg HIV Post transplant- need long term care and compliance with meds and appts. Living donors must be at least 18yrs

Answer 4

Regulates removal, storage and use of human tissue Consent is nearly always required to store human tissue Before organ donation the donor must be interviewed by an independent assessor fully familiar with Human Tissue Act and not a member of transplant team.

Answer 5

If a patient with capacity has requested or made an advance directive In best interests of an incompetent patient The right to life and the prohibition of inhuman or degrading treatment as outlined in The Human Rights Act 1998

Answer 6

Administration of large doses of medications to reduce pain and suffering may consequently hasten a patients death. Legal providing your intention was to relieve pain and suffering,

Answer 7

- Local incident reporting systems in each trust- IR1 (incident record 1) form or datix. - Incidents that have occured, near misses and incidents that might happen (eg due to faulty equipment) should be reported.

Answer 8

``` Any event (positive or negative) which is important or unusual and provides an opportunity to identify an area for learning, improvement or the dissemination of good practice eg unexpected deaths delayed or missed diagnoses medication errors communication failures. ```

Answer 9

1. Identify significant event 2. Collate information 3. Facilitated team-based meeting 4. Analysis of significant event 5. Agree, implement and monitor change 6. Write it up 7. Report, share and review findings

Answer 10

Being open and honest when things go wrong.

Answer 11

* Acute encephalitis * Acute infectious hepatitis * Acute meningitis * Acute poliomyelitis * Anthrax * Botulism * Brucellosis * Cholera * Diphtheria * Enteric fever (typhoid or paratyphoid fever) * Food poisoning * Haemolytic uraemic syndrome (HUS) * Infectious bloody diarrhoea * Invasive group A streptococcal disease * Legionnaires’ disease * Leprosy * Malaria * Measles * Meningococcal septicaemia * Mumps * Plague * Rabies * Rubella * Severe Acute Respiratory Syndrome (SARS) * Scarlet fever * Smallpox * Tetanus * Tuberculosis * Typhus * Viral haemorrhagic fever (VHF) * Whooping cough * Yellow fever

Answer 12

When a patient is never going to regain conciousness and never going to breath on their own again To diagnose it their must be a irreversible pathology causing brain damage - must be deeply unconscious and must have excluded hypothermia, drugs and metabolic disturbance as causes - must be apnoeic and requiring mechanical ventilation (this must not be due neuromuscular blockade)

Answer 13

Must be carried out by 2 different doctors with at least 5 years registered with GMC 1. Pupils must be fixed in diameter and not responsive to incident light. (Cranial nerves II, III). 2. There must be no corneal reflex (avoid damaging the cornea). (Cranial nerves V, VII). 3. Vestibulo-ocular reflexes are absent. No eye movements occur following the slow injection of at least 50mls of ice cold water over one minute into each external auditory meatus. Note that the normal reflex is devation of the eyes away from the side of the stimulus. Access to the tympanic membrane should be confirmed by otoscopy. Injury or pathology may prevent this test being performed on both sides – this does not invalidate the test. (Cranial nerves VIII, III). 4. No motor responses in the cranial nerve distribution should occur as a result of stimulation of any somatic area. No limb movement should occur in response to supra-orbital pressure. (Cranial nerves V, VII). 5. No gag reflex should occur in response to posterior pharyngeal wall stimulation with a spatula. (Cranial nerve IX). 6. No cough or other reflex should occur in response to bronchial stimulation by a suction catheter being passed down the endotracheal tube. (Cranial nerve X). 7. No respiratory movements should occur in response to disconnection from the ventilator. Hypoxia should be prevented by pre-oxygenation and insufflation of oxygen through a tracheal catheter. This tests the stimulation of respiration by arterial carbon dioxide tension which should be allowed to rise to 6.65 kPa – confirmed by arterial blood gases.

Answer 14

Sanctity of life- view that whenever possible human life should be maintained, could be argued as ethically unjustified if that results in suffering. Killing vs letting die Withholding vs withdrawing treatment: withdrawing treatment is a passive act and not killing

Answer 15

Competency- is psychiatric illness affecting her judgement or is overdose affecting judgement If lacks capacity then can treat by common law If has capacity can refuse treatment Mental Health act cannot be invoked to treat overdose patients.