Administering Meds to Pregnant Woman


#1

OK, last night i had a woman about 29, complaining of severe chest pain, radiation to her shoulder, and shortness of breath. her EKG showed severe tachycardia at about 186, with some indications of what looked like PVC’s (premature ventricular contrations) ----although ive never ever seen PVC’s at such a high heart rate. there wasnt such a pronouced deflection downward as youd think with a “regular” PVC.

she said she was about 3 weeks overdue on her period, and she thought she was pregnant, maybe about 6 weeks. i told her that she needed medication, namely AdenoCard to chemically cardiovert her. that meant administering morphine for analgeasia. she said she didnt want any meds because it might harm the child.

needless to say, while loading her in the ambulance, she goes unconscious. her EGK shows 210 bpm. now the law allows by implied consent, that any reasonable person would want lifesaving measures taken. so as soon as she goes out, the law tells me i can do anything i need to unless i have a written order otherwise.

i administered adenocard, getting good cardioversion, but the rate continued to increase to SVT, so i got orders from an MD to administer Amioderone, followed by a lidocaine drip in D5W solution. i didnt agree with the magnesium sulfate order, but once i get the directive, i HAVE to give it.

  1. amioderone and adenocard are known to have really bad effects in on fetal cells, as well as IV lidocaine.

  2. magnesium sulfate can induce contrations of the uterus, so there is a chance that the embro could have been expelled.

even if it was against the mother’s wishes, is it OK to administer meds that will most definitley harm an unborn child? i know the law fully allows the superceding of decisions when a person is no longer conscious, but what would be the CC church stance on such an issue?

does the CC oppose giving meds to SAVE a life (but hurt an embryo) against the prior verbally expressed wishes of a patient?


#2

Here is my take: Your intention was to alleviate whatever the medical problem at the time was. Your intention was NOT to hurt the embryo, therefore I don’t believe there is any culpability in what you have done.

As far as the mother wishes/law stuff, I’m not the one to answer that.


#3

In general the Church permits treatments that are designed to save the life of the mother but which indirectly/unintentionally cause harm to the unborn child.

The troubling aspect is that the mother didn’t want the treatment, even if it was only told to you orally.

I don’t know all the possibilities of what could have happened if you did not give her the prescribed treatment. But if it would have resulted in the death of the mother then I think you really had no choice. Obviously the death of the mother would have insured the death of the child, (assuming she is actually pregnant.) And it is possible that the treatment might not harm the baby.

I think you probably did the right thing.


#4

Being an ER nurse and having seen lots of EKG’s, she sounded like she was having PSVT’s,You definitely did the right thing by administering the medication Adenocard because PSVT most of the time will turn into V-Fib or V-Tac, which is a code situation and critical situation that could lead to death. most of the time with a regular Heart rate that fast, Im assuming it was regular, it is Psvt or sometimes atrial flutter. In the end this was a life threatening situation. Without the mother surviving, the baby surely wouldnt have. Its a benefit versus risk decision


#5

Bio- She didn’t say she WAS pregnant, only suspected.

Also, if she died right there in the ambulance, the baby would definetly died, so I would look at it like an eptopic pregnancy. Not ment to harm the baby- but to act to save the life of the mom. Intention is 99% of the deal…


#6

A very interesting question. You should ask a good priest. Just my opinion, but it would seem there are a few issues to sort out. First, you are obligated to treat the most serious condition that presents. Second, that the meds in question may affect the fetus, spontaneous abortion or birth defects, does not always mean that will happen in each case. Lastly, I do not know if anyone can bind another to not save a life if such measures are not extraordinary and has a reasonable chance of a full recovery. Then again, maybe she can.


#7

I think most reasonable women would understand that even though she expressed wishes to not have the medication because it possibly could hurt the baby, once she went unconscious, then her situation was more life threatening and you had to take the measures you took. It could be that while conscious, she was hoping that things would correct themselves, but since they didn’t and instead, turned for the worse, what you did was to save her life. After all, if she died, so did her baby, if she was pregnant. And, besides, there was no confirmation of pregnancy at that point anyway.


#8

[quote=joshua1]Being an ER nurse and having seen lots of EKG’s, she sounded like she was having PSVT’s…Im assuming it was regular, it is Psvt or sometimes atrial flutter.
[/quote]

youd think it was PSVT, but the telemetry i sent to the ER was reviewed by a cardiologist standing right there. he is the one who gave the order for magnesium sulfate after the amioderone and lidocaine drip by the ER attending. the cardiologist said it wasnt a “normal” ventricular arrythmia. he couldnt immediately identify it, so we treated it with drugs to slow down conduction velocity and restore Na/K pumps.

i have had two cases where almost no one could figure out the EKG, and one of them ended up in a medical journal for a new type of enzyme/co-factor defect. i only know because i have a masters in pharmacology and have published 2 articles, so i wanted in on that one too. it took an MD/PHD from Japan to identify it.

thats why i was concerned about giving those meds, because ultimately the condition might have been so esoteric that giving those meds might not help, and might hurt a baby.

you probably get even weirder EKG’s than i do. we dont have as large a sampling population for EGK’s as big ER. alot of times we dont bother doing an EKG.

if i can, i might be able to talk to the cardiologist and find out what it was, and send a copy of an EKG like it to you. it will trip you out, unless you have seen something like it.


#9

Even assuming this symptomatic patient with a HR of 190 had a CO compatible with rational thought, her oxygen consumption would surely prevent her ability to think clearly regarding her grave situation. Delaying or foregoing treatment until she arrests because she says she might be pregnant would not seem the best course of action IMHO.


#10

[quote=BioCatholic]youd think it was PSVT, but the telemetry i sent to the ER was reviewed by a cardiologist standing right there. he is the one who gave the order for magnesium sulfate after the amioderone and lidocaine drip by the ER attending. the cardiologist said it wasnt a “normal” ventricular arrythmia. he couldnt immediately identify it, so we treated it with drugs to slow down conduction velocity and restore Na/K pumps.

i have had two cases where almost no one could figure out the EKG, and one of them ended up in a medical journal for a new type of enzyme/co-factor defect. i only know because i have a masters in pharmacology and have published 2 articles, so i wanted in on that one too. it took an MD/PHD from Japan to identify it.

thats why i was concerned about giving those meds, because ultimately the condition might have been so esoteric that giving those meds might not help, and might hurt a baby.

you probably get even weirder EKG’s than i do. we dont have as large a sampling population for EGK’s as big ER. alot of times we dont bother doing an EKG.

if i can, i might be able to talk to the cardiologist and find out what it was, and send a copy of an EKG like it to you. it will trip you out, unless you have seen something like it.
[/quote]

You know, you are absolutely right. We get patients sometimes that are exhibiting every known symptom for a major myocardial infarction. You rush them to the back, hoook them all up to telemetry, put ivs in, give nitro, give aspirin, all the works, then look at the EKG and it is more normal than youre and mine. However, sometimes EKGS are only as good as the placement of the electrodes and the patient being still. That being said, the wierdest EKGS were the normal ones when the patient was showing every sign of trouble…go figure. In the end, nurse the patient, not the equipment


#11

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