From the Guidelines
The proper action in this scenario is option D: Go without consent as it is a lifesaving procedure. When a child presents with a subdural hematoma requiring urgent surgical exploration following a car accident, time is critical as this represents a life-threatening emergency. In such situations, the principle of implied consent applies, which allows medical professionals to proceed with necessary interventions to save life or prevent serious harm when obtaining explicit consent would cause harmful delay 1. While it would be ideal to have parental consent, the emergency nature of subdural hematoma evacuation takes precedence over waiting for the father's arrival or attempting to secure verbal consent by phone, which could introduce dangerous delays. Some key considerations in the management of such cases include:
- Ensuring the patient's trachea is intubated if the Glasgow Coma Scale (GCS) is ≤ 8 before any transfer, and using capnography during the transfer with all values between 4–5 kPa 1.
- Maintaining a mean arterial pressure (MAP) ≥ 90 mmHg at all times in patients with isolated traumatic brain injury (TBI) to prevent secondary brain injury 1.
- Avoiding actions that could exacerbate the condition, such as taping the eyes closed, which would prevent regular pupillary examination, and instead using regular moisturising eye drops or saline to prevent corneal drying 1. Medical professionals should document thoroughly the emergency circumstances that necessitated proceeding without formal consent. It's also important to note that the medical team should still make reasonable efforts to communicate with the father en route, informing him of the situation and the need for immediate intervention, but this communication should not delay the life-saving procedure. Once the father arrives, he should be fully informed about the procedure performed and the child's condition. The presence of a parent, if possible, is beneficial for accompanying the child during transfer and for facilitating consent for surgery at the receiving institution without delay, but it should not compromise the urgency of the required medical intervention 1.
From the Research
Urgent Medical Situation
In a situation where a child has suffered an isolated head injury with subdural hematoma and requires urgent exploration, the primary concern is the child's immediate health and well-being.
Legal and Ethical Considerations
- The studies provided do not directly address the issue of consent in emergency situations involving minors 2, 3, 4, 5, 6.
- However, in general medical practice, when a patient's life is at risk, medical professionals are authorized to provide emergency care without consent.
- This principle is guided by the doctrine of implied consent, which assumes that any reasonable person would want to receive life-saving treatment in an emergency situation.
Appropriate Course of Action
- Given the urgent nature of the situation and the need for immediate medical intervention, the most appropriate course of action would be to proceed with the lifesaving procedure without delay.
- This approach prioritizes the child's health and well-being over the need for consent, which can be addressed later when the child's condition is stable and the parents or legal guardians are available.
- Informing the father by phone and attempting to obtain verbal consent may be a considerate step, but it should not delay the necessary medical treatment.
Conclusion Not Applicable
As per the provided guidelines, the response should not include a conclusion section. Instead, the focus remains on the key points relevant to the situation:
- The child's immediate medical needs take precedence.
- Proceeding with lifesaving treatment is justified in emergency situations.
- The provided studies do not directly address consent in pediatric emergency situations but emphasize the importance of timely medical intervention in critical conditions 2, 3, 4, 5, 6.