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Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

Sushanth Reddy, MD, FACS, Laura Stafman, MD
    • Advance directives such as a living will, a do not resuscitate order, and a designation of a power of attorney for health care are legally binding mechanisms to preserve patient autonomy when patients have lost decision-making capacity. Although these directives are frequently used to make decisions regarding life-supporting therapy, surgeons may also need to refer to these documents or to patients’ surrogates for surgical decision making to treat patients in accordance with their autonomous wishes. There is some information to suggest that surgeons value the utility of an advance directive as it can serve as a guide to patients’ preferences in the postoperative setting when life-supporting therapy has become ineffective or patient survival is unlikely. 
    • The Physician Orders for Life-Sustaining Treatment (POLST) program was designed in Oregon in the 1990s to address the lack of advance directives in frail patients and those with chronic diseases. Although POLST is different from advance directives, both aim to address end-of-life care.
    • When patients do not have decision-making capacity, physicians are obliged to find someone who can make decisions for the patient. If the patient has previously designated a durable POAHC agent, this agent is the first person health care providers should turn to for decision making.

Diagnosis and Treatment of States of Shock 

Ahmed Reda Taha, MD, FRCP, FCCP, FCCM

    • New explanation for the pathogenesis of shock on the microvascular level, with detailed explanation of lethal corner and cellular death in different states of shock

    • The difference between systolic, diastolic, and mean blood pressure and their contribution to states of shock

    • Different vasopressors and their role in different types of shock

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

Sushanth Reddy, MD, FACS, Laura Stafman, MD
    • Advance directives such as a living will, a do not resuscitate order, and a designation of a power of attorney for health care are legally binding mechanisms to preserve patient autonomy when patients have lost decision-making capacity. Although these directives are frequently used to make decisions regarding life-supporting therapy, surgeons may also need to refer to these documents or to patients’ surrogates for surgical decision making to treat patients in accordance with their autonomous wishes. There is some information to suggest that surgeons value the utility of an advance directive as it can serve as a guide to patients’ preferences in the postoperative setting when life-supporting therapy has become ineffective or patient survival is unlikely. 
    • The Physician Orders for Life-Sustaining Treatment (POLST) program was designed in Oregon in the 1990s to address the lack of advance directives in frail patients and those with chronic diseases. Although POLST is different from advance directives, both aim to address end-of-life care.
    • When patients do not have decision-making capacity, physicians are obliged to find someone who can make decisions for the patient. If the patient has previously designated a durable POAHC agent, this agent is the first person health care providers should turn to for decision making.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

Sushanth Reddy, MD, FACS, Laura Stafman, MD
    • Advance directives such as a living will, a do not resuscitate order, and a designation of a power of attorney for health care are legally binding mechanisms to preserve patient autonomy when patients have lost decision-making capacity. Although these directives are frequently used to make decisions regarding life-supporting therapy, surgeons may also need to refer to these documents or to patients’ surrogates for surgical decision making to treat patients in accordance with their autonomous wishes. There is some information to suggest that surgeons value the utility of an advance directive as it can serve as a guide to patients’ preferences in the postoperative setting when life-supporting therapy has become ineffective or patient survival is unlikely. 
    • The Physician Orders for Life-Sustaining Treatment (POLST) program was designed in Oregon in the 1990s to address the lack of advance directives in frail patients and those with chronic diseases. Although POLST is different from advance directives, both aim to address end-of-life care.
    • When patients do not have decision-making capacity, physicians are obliged to find someone who can make decisions for the patient. If the patient has previously designated a durable POAHC agent, this agent is the first person health care providers should turn to for decision making.

Diagnosis and Treatment of States of Shock 

Ahmed Reda Taha, MD, FRCP, FCCP, FCCM

    • New explanation for the pathogenesis of shock on the microvascular level, with detailed explanation of lethal corner and cellular death in different states of shock

    • The difference between systolic, diastolic, and mean blood pressure and their contribution to states of shock

    • Different vasopressors and their role in different types of shock

Pediatric Lower Respiratory Tract Emergencies: Bronchiolitis, Pneumonia, and Asthma

    • Bronchiolitis is a clinical diagnosis; supportive therapy including supplemental oxygen, hydration, and nutrition are key.
    • Prematurity, young age, and underlying medical comorbidities predispose patients to severe bronchiolitis.
    • Knowledge of the different pathogens affecting children of various ages paramount to best antibiotic choice
    • Thorough history on patients presenting to the emergency department with asthma symptoms should be obtained; children with significant respiratory distress, hypoxia, suboptimal response to therapy, or poor social situation should be admitted.
    • Current guidelines recommend increasing medical management in a stepwise fashion based on level of control.

Fundamentals of Endovascular Surgery

    • Preprocedure patient evaluation and appropriate patient selection as well as guidelines for procedure set-up
    • Vascular access site selection and access technique based on anatomic location as well as troubleshooting with difficult access sites
    • Appropriate guide-wire and catheter selection as well as basic instructions in their use
    • Appropriate use of angioplasty balloons, stents, and guide sheaths
    • Vascular closure devices and postoperative care

Fundamentals of Endovascular Surgery

    • Preprocedure patient evaluation and appropriate patient selection as well as guidelines for procedure set-up
    • Vascular access site selection and access technique based on anatomic location as well as troubleshooting with difficult access sites
    • Appropriate guide-wire and catheter selection as well as basic instructions in their use
    • Appropriate use of angioplasty balloons, stents, and guide sheaths
    • Vascular closure devices and postoperative care
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