case 3

72 F HX OF ESOPHAGEAL CA

• DISTAL ESOPH STENT PLACED 2/52
• NO CURRENT CTX
• FEELS VAGUE FLANK PAIN
• NO RIGORS, FEVER, DYSURIA
• FAMILY REPORTS DEHYDRATION DUE TO DECREASED INTAKE SINCE STENT

CONCURRENTLY

• INVESTIGATIONS
• METOCLOPRAMIDE
• IVF
• GOC CONVERSATION WITH FAMILY
• RELUCTANT DECISION TO BE DNR M3 AFTER DISCUSSION-FAMILY DYNAMICS AT PLAY

STAT CALL FOR SEIZURE

? SZ? POST ICTAL?

• SPO2 80%
• GCS 3/TACHY/N GLUCOSE
• TAKEN TO RESUS ROOM
• RAPID DISCUSSION WITH FAMILY RE: GOC
• NEXT STEPS?
• DNR M3...

WE WANT EVERYTHING

COURSE

• RSI
• NO CHANGE IN O2
• POCUS RV N, NO PTX, PCE
• NO FF
• TAKEN TO CT
• LEVO 12MCG

OUTCOME

• NO PE/ DRY BRAIN N/LABS 'N'
• ACTIVE EROSION OF TUMOUR
• AORTA VIGOROUSLY BLEEDING INTO DISTAL ESOPHAGUS

CONCLUSION

• D/W IR/GI-NO GOOD OPTIONS OFFERED
• MOVED TO COMFORT CARE
• DIED WITHIN THE HOUR