Ethical Issues and Risks Associated Assignment

Ethical Issues and Risks Associated with Assignment
Order 5979234
Ethical Issues and Risks Associated with Assignment
A 65-year-old man presents to his local emergency
department with 2 hours of severe substernal chest
pain. The initial 12-lead electrocardiogram (EKG)
reveals an acute injury pattern with 2 mm STsegment elevation in leads II, III, aVF, as well as
V5 and V6. His blood pressure is 125/75 mm Hg
and his heart rate is 90 beats per minute and
regular. The lung examination demonstrates rales
throughout the lung fields. His pain is mostly relieved
by intravenous nitroglycerin infusion. There is no
on-site cardiac surgery capability at this facility,
but a board-eligible interventional cardiologist has
recently been added to the medical staff, and an
acute interventional program has been initiated at
the hospital. The nearest facility with on-site surgery
is approximately 30 minutes away by ambulance.
What is the appropriate management of this patient?
(A) Treat the patient with IV thrombolytic therapy
along with routine medical therapy and observe
for evidence of reperfusion
(B) Because the patient’s discomfort has been largely
relieved by intravenous nitroglycerin, admit the
patient to the coronary care unit (CCU) for
observation
(C) Proceed with urgent cardiac catheterization for
possible coronary intervention
(D) Give thrombolytic therapy and immediately
transfer to the nearest facility with both interventional and surgical backup
(E) Transfer immediately to the nearest facility
with both interventional capability and surgical
backup without initiating thrombolysis
2 Your catheterization laboratory is reviewing policy
concerning which personnel are qualified to perform
coronary interventions. Which of the following
statements is false?
(A) A physician must be a full member of the
hospital staff to be granted privileges to perform
percutaneous coronary intervention (PCI) in
the cardiac catheterization laboratory
Ethical Issues and Risks Associated Assignment
(B) A primary operator must have completed an accredited fellowship in interventional cardiology
and therefore be Board-eligible, or must have
earned an American Board of Internal Medicine
(ABIM) Certificate of Added Qualification in
Interventional Cardiology
(C) The primary operator for PCI must have
performed >250 coronary interventions in
training, and must perform >75 PCI per year as
primary operator
(D) An invasive cardiologist who has watched or
participated in a total of 100 interventional
procedures at a neighboring tertiary referral
hospital, where the cardiologist drove once
weekly to participate in cases, may be granted
privileges to carry out interventional cardiology
procedures
326
Ethical Issues and Risks Associated with Catheterization and Interventional Procedures 327
3 A 45-year-old man with a history of hypertension
and cigarette smoking presents to the office of
a Board-certified interventional cardiologist with
coronary and peripheral artery expertise, with recentonset exertional chest discomfort as well as pain
in the right calf with walking. The cardiac exam
and resting EKG are normal. Exercise echo stress
test results are consistent with inferior ischemia.
Coronary arteriography is subsequently performed
and demonstrates important two-vessel involvement
amenable to PCI, with a 90% unstable-appearing
proximal right coronary artery stenosis and a 75% left
anterior descending stenosis, but no significant left
main or circumflex disease. There is difficulty noted
in guidewire passage into the central aorta from
the right iliac. Left ventriculography demonstrates
normal wall motion. After completion of the
diagnostic portion of the procedure, the patient
reports he has been experiencing chest discomfort
and discomfort in the right thigh that has worsened as
the procedure has progressed. Right iliac and femoral
angiography demonstrates a 90% right common iliac
stenosis. On the basis of these findings, how best
should the interventional cardiologist proceed?
Ethical Issues and Risks Associated Assignment
(A) End the procedure and schedule the patient for
left anterior descending and right coronary PCIs
and right iliac intervention at three separate
procedures
(B) Carry out PCI only for right iliac stenosis and
have the patient return for coronary intervention at a later date
(C) Perform PCI for both coronary lesions and
have the patient return at a later date for iliac
intervention
(D) Carry out right coronary and right common
iliac interventions and have the patient return
for left anterior descending intervention
Having hard time figuring how to do your assignment?
Hire our experts and have it done in no time!