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August 2015

Does My Mother Really Need That Central Line?

Author Affiliations
  • 1Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2015;175(8):1267. doi:10.1001/jamainternmed.2015.2296

Her name was Claire. She resided in a local nursing home and had advanced dementia, coronary artery disease, diabetes mellitus, and hypertension. She was nonverbal from multiple prior cerebrovascular accidents and her worsening dementia. When I opened her medical record, an orange Do Not Resuscitate/Intubate sheet shined through her thick stack of medical records. She had come to the emergency department because her nurse noted hypoxia and tachypnea earlier that day. While in the emergency department, Claire’s blood pressure dropped, despite adequate volume resuscitation. The indication was clear: septic shock secondary to pneumonia. As an intern, I had absorbed the principles of sepsis care that my attending physicians inculcated into me. I knew the next step; she needed vasopressors.

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