A 12-year-old boy with Down syndrome is brought to the emergency department by ambulance after being in a motor vehicle collision. The patient was a restrained, rear seat passenger who required extrication from the vehicle. Temperature is 36.1 C (97 F), blood pressure is 89/60 mm Hg, pulse is 128/min, and respirations are 24/min. The patient is unconscious and has a cervical neck collar in place. Multiple lacerations to his face, arms, and abdomen are noted. A large hematoma is noted across the upper pelvis. His 17-year-old sister, who was driving the boy to music class, is present. The sister has several contusions from the airbag but is otherwise alert and oriented. She is distressed about her brother and says that he has severe impairment in intellectual functioning and requires constant supervision. The sister states that their parents are on a flight, but they are due to land in the next 30 minutes and can then be contacted by phone. The grandparents, who also live with them, do not have mobile phones but are expected to arrive in the emergency department within the next 5-10 minutes. Which of the following is the best next step in management of this patient?

Question

A 12-year-old boy with Down syndrome is brought to the emergency department by ambulance after being in a motor vehicle collision.  The patient was a restrained, rear seat passenger who required extrication from the vehicle.  Temperature is 36.1 C (97 F), blood pressure is 89/60 mm Hg, pulse is 128/min, and respirations are 24/min.  The patient is unconscious and has a cervical neck collar in place.  Multiple lacerations to his face, arms, and abdomen are noted.  A large hematoma is noted across the upper pelvis.  His 17-year-old sister, who was driving the boy to music class, is present.  The sister has several contusions from the airbag but is otherwise alert and oriented.  She is distressed about her brother and says that he has severe impairment in intellectual functioning and requires constant supervision.  The sister states that their parents are on a flight, but they are due to land in the next 30 minutes and can then be contacted by phone.  The grandparents, who also live with them, do not have mobile phones but are expected to arrive in the emergency department within the next 5-10 minutes.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c0ce_0394_8f63_e9c38e58cddc_MD0005_00 A parent or legal guardian of a minor typically must provide informed consent for routine medical care. If immediate medical care is necessary to prevent serious harm or death, consent is implied. This patient experienced life-threatening, traumatic injuries: He is unconscious and tachycardic with a pelvic hematoma concerning for internal hemorrhage. Withholding treatment until parental consent is obtained may lead to death (Choice A). Therefore, treatment should be provided for this child without consent. (Choices B and C) Although some states allow adult siblings or grandparents to provide consent if a parent or legal guardian is unavailable, this child's sister is a minor and the grandparents are not readily available. Treatment of life-threatening injuries should not be withheld for even 5 or 10 minutes to obtain consent from the grandparents. (Choice D) A court order is typically obtained when parents refuse medically necessary, nonemergent treatment for a child, not when they are unavailable to provide consent, as in this case. In an emergency, care should not be delayed by petitioning the court. Educational objective: A parent or legal guardian is typically required to consent for medical care of a minor. However, if immediate medical care is necessary to prevent serious harm or death, treatment may be provided without seeking consent. References: Consent for emergency medical services for children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/21788221)

A 12-Year-Old Boy with Down Syndrome Is Brought to the Emergency