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1. Summarize the medical history.
2. What was the patient’s status upon arrival of paramedics? During transport? In the emergency room? Are there any discrepancies?
If so, how do you account for them? (see medical records)
3. What choices affected the patient’s care starting from home through to the emergency room?
4. Are there any choices that were intended to help but which may have led to worsening of his condition?
5. What is your opinion on “assigning fault” in a death? How would you talk with someone who intended to help a patient, but ended up harming them? What if this were a family member? Does any of this apply to this case? How?
6. What ethical issues are raised in the medical record titled “View additional emergency room note”?
7. The history states there were three attempts at intubation. What factors can make intubation difficult? List ones that are related to the patient. List ones that are related to the provider.
8. Create your own definition of what it means to be a “competent” health care provider. Can you imagine an adverse outcome with “competent care”?
9. Come back to questions 1 – 8 after studying the videos and decide if you wish to revise any of your answers.
10. Inventory the physical findings in the video.
11. What surgeries did the patient have? How many total surgeries did the patient have?
12. Are there any post-surgical complications? What are they?
13. Does the patient have an infection?
14. What are the signs of infection in the skin?
15. What is necrosis? Does the patient have necrosis? Does necrosis imply infections? What else can cause necrosis?
16. Based on the external exam, what anatomic changes will you be checking for inside the abdomen?
17. Based on the external exam, what post-surgical complications could you see inside the abdomen?
18. What is the difference between a gastrotomy tube and a jejunostomy tube?
19. Which tube is which in the patient? Why would a patient have both?
20. How many decubitus ulcers does the patient have? Where are they? Grade them.
21. Do you think this patient functioned independently, semi-independently or was completely dependent on care? What is your evidence.
22. Assess the patient’s muscle mass. How does that correlate with the rest of the physical exam.