POSTER ABSTRACTS 1- 48: 2021 ASCIP Hybrid Educational Conference & Expo

Abstract

Context: This is a case of a 71-year-old male who presented with sudden onset tetraplegia after a mechanical ground level fall. He was diagnosed with a traumatic C3 AIS B spinal cord injury (SCI) and neurogenic shock requiring vasopressors and intubation. He underwent C3-C5 surgical decompression and stabilization. His course was complicated by cardiac arrest, aspiration pneumonia, alcoholic pancreatitis, and failure to wean off vasopressors. Findings: The patient was alert and intermittently cognitively intact, but his communication was limited by intubation. The healthcare team discussed his likely prognosis including long-term artificial ventilation, tube feeding, and severe tetraplegia. Under COVID-19 restrictions, the patient's wife, his durable power of attorney, and son had limited encounters with the patient. Initially, she wanted to pursue tracheostomy so the patient may participate in goals of care discussions. However, the family recalled his preference to not be on life support. The decision was made to withdraw care and he passed away on hospital day 11. Conclusion/Clinical Relevance: This case highlights the ethical dilemma of withdrawing care in the acute phase of a severe traumatic SCI. While undergoing intensive care, many factors interfere with decision making including the patient's acute medical status, altered cognition, communication limitation, and the family's physical distance and emotional state. Lastly, the patient and his family may not have had sufficient time to process the given information and understand that a meaningful life is possible with a severe disability. Informed decision making includes not only clear and thorough information but also time to adjust.