Step 1

Behavioral 7

A 69-year-old woman is transported to the emergency department by emergency medical services after a fall in a nursing home facility. She is accompanied by several family members who report a history of severe Alzheimer dementia. She has had several recent falls which required emergency department visits and a near-fatal bout of pneumonia two months ago which required a prolonged hospitalization. During the most recent inpatient stay, her son who is her healthcare power of attorney signed documents for do not resuscitate (DNR) and do not intubate (DNI) orders in the event of a cardiac or respiratory arrest. On physical examination, she is noted to be obtunded and then goes into cardiac arrest. She has no palpable pulses, and her respirations are irregular. Her daughter and grandson ask the medical staff to begin cardiopulmonary resuscitation (CPR).

Which of the following is the most appropriate action by the medical staff?

  • A) Consult the critical care team to begin cardiopulmonary resuscitation
  • B) Consult the hospital ethics committee for recommendations
  • C) Do not pursue intubation or resuscitation efforts
  • D) Intubate the patient and begin chest compressions and mechanical ventilation
  • E) Obtain a court order to intubate and resuscitate the patient


Dr. Ted O'Connell

Bryce Baird


Dr. Ted O'Connell