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For whom the bells knell.

M Heim1, T Steinbach

  • 1Orthopaedic Rehabilitation Department, Sheba Medical Center, Israel.

Journal of Medical Ethics
|September 1, 1988
PubMed
Summary
This summary is machine-generated.

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This case study highlights severe lower limb gangrene and pressure sores in a patient with organic brain syndrome. Surgical intervention was debated due to the patient's condition and the extent of tissue decomposition.

Area of Science:

  • Geriatric Medicine
  • Wound Care
  • Infectious Diseases

Background:

  • A 72-year-old female with organic brain syndrome presented with severe lower limb gangrene.
  • The gangrene stemmed from hip adduction contracture causing pressure ulcers on the left leg.

Observation:

  • The patient had extensive pressure sores on both trochanters and the sacrum.
  • Visible decomposition and large worms were noted in the affected tissues.
  • The patient was febrile, unaware of her surroundings, and experienced no pain.

Findings:

  • Surgical amputation was deemed unlikely to improve the patient's cognitive status or quality of life.
  • The large sacral pressure sore precluded surgical closure.
  • Abstinence from surgery presented a significant risk of sepsis and caused distress to caregivers.
Keywords:
Death and EuthanasiaProfessional Patient Relationship

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Implications:

  • This case underscores the complex ethical and clinical challenges in managing severe pressure-related complications in patients with cognitive impairment.
  • It highlights the need for careful consideration of surgical risks versus benefits in palliative care scenarios.
  • The management of extensive tissue necrosis and potential sepsis requires a multidisciplinary approach.