Hej. Lyssnade på er härliga diskussion om bl a begreppet vitalindikation. Håller med om att det är ett laddat begrepp och hur en bra tolkning ska göras… Har själv i arbetet som sjuksköterska stött på detta i lite olika sammanhang, men har ett tillfälle som etsat sig fast i mitt minne angående en patient med mångårig problematik och där begreppet vitalindikation används på ett ganska speciellt sätt. För att göra en kort anamnes handlar det om en patient i 50-årsåldern som initialt fick en ryggskada i 30-årsåldern med mycket smärtproblematik i efterförloppet och därav också en opioidöverkonsumtion. Efter lång och jobbig avgiftning så lyckades han trots allt komma tillbaka till att börja jobba igen men hade oturen av att drabbas av ett rejält ileus som inte gick att lösa utan operation och därefter var han igång igen med opioider… Efter den initiala operationen (som var 2007) har man hittills behövt öppna honom 3 gånger igen och han har ofta, ofta dykt upp på akuten med buksmärtor och på 1 år gjordes säkert 40-45 röntgenundersökningar (BÖS) på honom. Till slut var det en av överläkarna på sjukhuset som skrev in i hans journal att om han dök upp på akuten fler gånger skulle han smärtlindras med paracetamol, papaverin, ibuprofen och möjligen stesolid som starkaste läkemedelsval, han skulle ges gastrografin i ett försök att lösa ett eventuellt begynnande ileus och han fick endast skickas på röntgen om det var på vitalindikation, likaså fick opioider endast ges på vitalindikation. Denna patient har numera flyttat till en annan del av landet och jag vet inte fortsättningen på hans ganska sorgliga historia, det kan ju hända att han inte ens lever längre. Till saken hör också att de första två ingreppen gjordes i ett landsting, den andra i ett annat och den tredje i ytterligare ett landsting, där han vistades högst tillfälligt och inte hade någon journal alls sen tidigare eller var känd som patient. När han kom på sitt ”hemsjukhus” eller övriga inom samma region så fanns ju all bakgrundsfakta i hans journal och han fick inte bara en massa morfin mm som egentligen var det som han ville ha och han tyckte om att bli röntgad….
Men jag tycker att det var ett lite annorlunda initiativ av den ÖL som skrev detta i hans journal och ett annorlunda sätt att använda begreppet vitalindikation.
Väldigt intressant diskussion om vad kan anses som vital indikation. Om jag minns rätt från SVT dokumentär fanns dock en patient som blev opererad med den artificiella luftstrupe och, eftersom funkade inte allt, opererades om med en djurstrupe och överlevde. Då frågan är, var verkligen den här fallet tillsammans med Julias fall på vitala indikation? Hade man verkligen inte möjligheten att utföra en akut etisk analysis?
Ganska pinsamt och förnedrande KI beteende som drabbade tyvärr alla medarbetare och patienter själva som Märit har understrukit. Hoppas verkligen att KI kommer att få tillbaka det goda rykte som hade intjänat under så många år.
Jag lyssnar flera gånger varje dag på Ronden; i bilen, när jag lagar mat etc. Underbar podd!
Jag vill inte kommentera på Macchiarini, mer än att det är bra att ni väntade lite med att prata om det. Få lite perspektiv innan.
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Hej. Lyssnade på er härliga diskussion om bl a begreppet vitalindikation. Håller med om att det är ett laddat begrepp och hur en bra tolkning ska göras… Har själv i arbetet som sjuksköterska stött på detta i lite olika sammanhang, men har ett tillfälle som etsat sig fast i mitt minne angående en patient med mångårig problematik och där begreppet vitalindikation används på ett ganska speciellt sätt. För att göra en kort anamnes handlar det om en patient i 50-årsåldern som initialt fick en ryggskada i 30-årsåldern med mycket smärtproblematik i efterförloppet och därav också en opioidöverkonsumtion. Efter lång och jobbig avgiftning så lyckades han trots allt komma tillbaka till att börja jobba igen men hade oturen av att drabbas av ett rejält ileus som inte gick att lösa utan operation och därefter var han igång igen med opioider… Efter den initiala operationen (som var 2007) har man hittills behövt öppna honom 3 gånger igen och han har ofta, ofta dykt upp på akuten med buksmärtor och på 1 år gjordes säkert 40-45 röntgenundersökningar (BÖS) på honom. Till slut var det en av överläkarna på sjukhuset som skrev in i hans journal att om han dök upp på akuten fler gånger skulle han smärtlindras med paracetamol, papaverin, ibuprofen och möjligen stesolid som starkaste läkemedelsval, han skulle ges gastrografin i ett försök att lösa ett eventuellt begynnande ileus och han fick endast skickas på röntgen om det var på vitalindikation, likaså fick opioider endast ges på vitalindikation. Denna patient har numera flyttat till en annan del av landet och jag vet inte fortsättningen på hans ganska sorgliga historia, det kan ju hända att han inte ens lever längre. Till saken hör också att de första två ingreppen gjordes i ett landsting, den andra i ett annat och den tredje i ytterligare ett landsting, där han vistades högst tillfälligt och inte hade någon journal alls sen tidigare eller var känd som patient. När han kom på sitt ”hemsjukhus” eller övriga inom samma region så fanns ju all bakgrundsfakta i hans journal och han fick inte bara en massa morfin mm som egentligen var det som han ville ha och han tyckte om att bli röntgad….
Men jag tycker att det var ett lite annorlunda initiativ av den ÖL som skrev detta i hans journal och ett annorlunda sätt att använda begreppet vitalindikation.
Hej!
Tack för ditt inlägg. Mycket spännande diskussion. Tack för att du lyssnar på ronden!
Väldigt intressant diskussion om vad kan anses som vital indikation. Om jag minns rätt från SVT dokumentär fanns dock en patient som blev opererad med den artificiella luftstrupe och, eftersom funkade inte allt, opererades om med en djurstrupe och överlevde. Då frågan är, var verkligen den här fallet tillsammans med Julias fall på vitala indikation? Hade man verkligen inte möjligheten att utföra en akut etisk analysis?
Ganska pinsamt och förnedrande KI beteende som drabbade tyvärr alla medarbetare och patienter själva som Märit har understrukit. Hoppas verkligen att KI kommer att få tillbaka det goda rykte som hade intjänat under så många år.
Hej Paolo
Tack för input!
/Christian
Hej kära Ronden!
Jag lyssnar flera gånger varje dag på Ronden; i bilen, när jag lagar mat etc. Underbar podd!
Jag vill inte kommentera på Macchiarini, mer än att det är bra att ni väntade lite med att prata om det. Få lite perspektiv innan.
Istället: vill ni ta upp zika och det nu klara sambandet med hjärnskador hos foster? Det är såklart väldigt tragiskt och jag undrar saker som tex. varför kommer hjärnskadorna nu när zika funnits så länge?
Tack!
Hej Caroline!
Tack för feedback. ZIka, bra ämne. Klart vi ska snacka om det.
/Christian
Pingback: Linköpings universitet: Mathildas blogg » Bloggarkiv » Tjafs
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