A fit and healthy 65-year old man was hit by a motorcycle while out jogging in the evening and was admitted to a district general hospital. On examination, he was found to have suffered a complicated fracture of his hip, which required specialist input. He was due to be transferred to a tertiary medical centre for further management. Unfortunately, due to the shortage of beds, he waited 6 days before being transferred.
On the day of his operation, as he was lying on the operating table, he suffered a cardiac arrest secondary to a massive pulmonary embolism (clot in the lungs). They performed CPR for a total of 45 minutes before a return of spontaneous circulation was obtained. Unfortunately, during that time, the brain lacked oxygen and he suffered hypoxic brain injury.
The operation was postponed and he was transferred to the unit for post-cardiac arrest management. Following stabilisation of his condition, he had his operation 2 days later. Unfortunately, his neurological status never improved due to the prolonged hypoxic brain injury.
What is the next management plan for him? What will his quality of life be? Considering that he will very likely be mentally-disabled for life, is prolonging his life in his best interest?
Difficult issues to consider, difficult decisions to make. What would you do?
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