To Ventilate or Not

Opening
(Introduce/clarify/comfortable/purpose/what he understands)

Issues
 Task – Informing how ill father is, premorbid and ventilation
 (medical/legal/ethical, listen/summarise/advise, social, ICE and 9 issues)
 Task 1 – Informing how ill father is
o Update on latest findings at the A&E eg pneumonia, clinical state and blood
test and CXR results
o Coupled with his underlying condition
o Currently, how doctors are managing him
o Patient is ill such that he will pass away soon unless he is artificially
supported by a machine to breathe
o “In order to advice you on the options, I need to discuss with you about his
condition”
 Task 2 – premorbid
o Normal state, ADLs
o Ex tolerance
o Depressed?
o Condition eg COPD
 Severity, LTOT, Neb, requirement on LTOT or prn
 Admission, ICU, intubation, cx, difficulty weaning off
o Other condition
 Task 3 – ventilation
o Options – Place him on a face mask vs NIPPV vs ventilation
o The first 2 are likely to fail and his risk of death is high
o Ventilation
 Aim and benefits – remedial reason, first episode, acceptable quality of
life
 Discouraging factors – advance COPD with poor quality of life
 Procedure – “a plastic tube passed into windpipe and connected to a
machine” and “tubes in the arms and neck for fluids and antibiotics”
 Risk – infection, pneumothorax “lung bursting”, difficulty weaning
off, psychosis and death
o Check if patient has stated any views, living will
o Check family and relatives’ view

Closing
(Summarise/support/plan/next appointment/pager no)