Utilazation Of Medical Resources And Ethics

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Utilazation Of Medical Resources And Ethics

  1. 1. To Treat or not to treat?<br />A health care reform debate<br />J. Alberto Martinez, M.D.<br />
  2. 2. Case presentation. History<br />RS is an 85 Y.O. male referred emergently by an ophthalmologist for a severe corneal ulcer, left eye.<br />CC: Seven day history of decreased vision and discharge, left eye. Denies pain.<br />Patient is on his last few radiation treatments for throat cancer.<br />Mr. RS lives with a septuagenarian couple who are his friends and help take care of him.<br />Patient still smokes ½ pack of cigarrettes per day<br />
  3. 3. EXAM<br />Fragile, cachectic male able to ambulate slowly. <br />Able to cooperate, slowly, grumpily.<br />VA: OD: sc 20/25 OS: sc: HM<br />Poor blink OU<br />Normal anterior segment OD, well centered IOL<br />OS: Massive corneal infiltrate with bulging cornea. No seidel’s, deep anterior chamber, pseudophakic.<br />
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  6. 6. Diagnosis and Treatment<br />Corneal ulcer, severe, probably associated with exposure keratopathy<br /> TREATMENT?<br />
  7. 7. Initial Treatment<br />Corneal scraping for culture and sensitivity<br />Start VigamoX every 1 hour around the clock until fortified antibiotics ( Ancef and Gent) obtained. Shield<br />Assesed home condition, spoke with social worker, home friends to improve compliance, given patient’s general condition.<br />Daily follow-up.<br />
  8. 8. Clinical Evolution<br />Infiltrate appeared to get smaller over the next three days. Compliance appeared to be good. Difficulties with transportation.<br />Cultures were negative.<br />On the fourth day, the chamber collapsed<br />
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  11. 11. Now What?<br />To transplant or not?<br />No transplant: Ulcer may be sterilized, perforation would be vascularized, eye would eventually may become pthisical.<br />Transplant: 90% plus chances of saving the eye and eventually good vision.<br />Patient given the option: “he wants his eye”<br />
  12. 12. ETHICS<br />Should we invest about $10,000 on this eye?<br />Patient’s quality of life would be essentially unchanged with a successful transplant.<br />Cost to SOCIETY.<br />
  13. 13. Treatment<br />
  14. 14. Treatment<br />
  15. 15. Discussion<br />Utilization of limited health care resources<br />Who makes the decision?<br />

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