Communication in an Emergency

Case Study: Communication in an Emergency

Mr. Walsh is a 68-year-old man who was admitted to the cardiac care unit (CCU) 2 days ago after a myocardial infarction (MI; “heart attack”). It was determined that he had a 95% blockage in his left anterior descending coronary artery, and a stent was inserted. He showed steady improvement and was able to ambulate short distances without difficulty. He was transferred to the cardiac step-down unit. He has advance directives on file and is to be resuscitated in the event of a cardiac arrest. His wife and daughter are visiting.

Mr. Walsh’s monitor begins to alarm as you enter the room. His daughter says, “He says he can’t breathe.” You (the respiratory therapist) quickly assess the abnormal cardiac rhythm on the monitor (ventricular tachycardia) and call the rapid response team. His wife and daughter are confused by the sequence of events and anxious. As you begin to assess him, he goes into cardiac and respiratory arrest. After finding no carotid pulse, you begin cardiopulmonary resuscitation just as the rapid response team arrives.

Discussion Questions

1. What information needs to be communicated to Mr. Walsh’s wife and daughter, by whom, and in what form?
2. Should Mr. Walsh’s wife and daughter be given the choice to stay in the room?
3. Explain your choice. How will you communicate this (your choice) to them?
4. Anticipate the feedback that you might get from Mr. Walsh’s wife and daughter after your communication. Propose how you will respond to that.
5. What (and how) will you communicate to the rapid response team?

1. What information needs to be communicated to Mr. Walsh’s wife and daughter, by whom, and in what form?

The information that needs to be communicated to Mr. Walsh’s wife and daughter includes:

• The fact that there is a medical emergency.
• The specific condition Mr. Walsh is experiencing (ventricular tachycardia).
• The actions being taken by the healthcare team, such as initiating CPR and calling the rapid response team.
• The potential seriousness of the situation, without causing unnecessary panic.

The communication should be done by a healthcare professional, ideally a physician or nurse, who is well-versed in providing updates to family members. The information should be conveyed in a clear and empathetic manner, using simple and jargon-free language to ensure the family understands the situation.

2. Should Mr. Walsh’s wife and daughter be given the choice to stay in the room?
3. Explain your choice. How will you communicate this (your choice) to them?

The decision to allow Mr. Walsh’s wife and daughter to stay in the room should be based on the clinical situation and the potential impact on the family’s emotional well-being. In this case, Mr. Walsh has gone into cardiac and respiratory arrest, which is a critical and distressing situation. Allowing them to stay in the room may not be in their best interest, as witnessing such a traumatic event can be highly distressing and emotionally overwhelming.

To communicate this choice to them, a healthcare professional should approach them with empathy and sensitivity. They can say something like, “I understand that you want to be with Mr. Walsh right now, but the situation is very critical, and it can be quite distressing to witness. For your own well-being, it may be best for you to step out of the room for a moment while we work to stabilize him. We will keep you updated on his condition.”

4. Anticipate the feedback that you might get from Mr. Walsh’s wife and daughter after your communication. Propose how you will respond to that.

It is possible that Mr. Walsh’s wife and daughter may be upset or anxious about being asked to leave the room. To address their feedback, it’s important to maintain empathy and understanding. You can respond by saying:

• “I understand that this is a difficult and distressing situation, and we appreciate your concern for Mr. Walsh. Our primary goal is to provide the best possible care for him, and sometimes, in emergency situations like this, it’s essential to focus on medical interventions without additional distractions. We will keep you informed and bring you back into the room as soon as we can.”

Offering reassurance and clear communication about the ongoing care and updates on Mr. Walsh’s condition will help alleviate their anxiety and concerns.

5. What (and how) will you communicate to the rapid response team?

To communicate effectively with the rapid response team, you should provide essential information quickly and clearly. Here’s what to communicate:

• The patient’s name: “Mr. Walsh is in room [room number].”
• The situation: “Mr. Walsh is in ventricular tachycardia and has gone into cardiac and respiratory arrest.”
• The actions taken: “CPR has been initiated.”
• The current status: “No carotid pulse is detected.”

You should convey this information calmly and directly, using clear and concise language. Ensure that the team understands the urgency of the situation and that they should respond promptly. Additionally, provide any relevant medical history or advanced directives information, such as Mr. Walsh’s resuscitation status, to guide their actions.