A 7-year-old male is hospitalized after sustaining abdominal trauma in an accident. The child is conscious. His pulse rate is 150 beats/min, his systolic blood pressure is palpated at 60 mm Hg, and his respiratory rate is 40/min. His hemoglobin level is 4.0 g/dL because of trauma-related blood loss. His clinical condition is deteriorating despite an infusion of intravenous volume expanders, but the parents are Jehovah’s Witnesses and refuse to consent to a blood transfusion because of their religious convictions. Your prognosis is that without a blood transfusion the patient will die.
According to medical-legal precedent, which one of the following is correct?
Correct Answer A:
The refusal to accept any medical intervention, including life-saving blood transfusions, has been well established for adults who have the ability to definitively communicate their wishes. Also, parents have the power to give or withhold consent to medical treatment on behalf of their children. However, Western courts have deemed that parents cannot refuse emergency, life-saving treatment to children based on these principles: (1) the child’s interests outweigh parental rights to refuse medical treatment; (2) parental rights do not give parents life and death authority over their children; and (3) parents do not have an absolute right to refuse medical treatment for their children, if that refusal is regarded as unreasonable.
Black cohosh is:
Correct Answer B:
Black cohosh is an herbal preparation widely used in the treatment of menopausal symptoms and menstrual dysfunction. Studies have demonstrated that this botanic medicine appears to be effective in alleviating menopausal symptoms. It has not been proven effective in randomized controlled trials and should not be used to prevent osteoporosis. Questions as to its stimulating effect on endometrial tissue are as yet unanswered.
An elderly male patient takes aspirin, 81 mg daily, for prevention of a heart attack. He also takes herbal supplements.
Which one of the following supplements can have a negative interaction with aspirin?
Correct Answer E:
Herbal and dietary supplements can affect the absorption, metabolism, and disposition of other drugs. Ginkgo biloba has been associated with serious intracerebral bleeding. In most of these patients, concurrent anticoagulant drugs were being used. Ginkgo has been shown in vitro to inhibit platelet aggregation and has been associated with case reports of spontaneous bleeding. Caution is recommended when using this supplement with aspirin or other anticoagulants. Kava is associated with gastrointestinal side effects and skin rashes. Yohimbine is associated with hypertension. Saw palmetto and echinacea are not associated with bleeding.
A 30-year-old female requests advice about the use of oral contraceptive pills (OCP).
In discussing potential risks you explain that OCPs may:
The risk of ovarian cancer is decreased by at least half among women who use oral contraceptives, including those who use low-estrogen formulations. With the use of oral contraceptives, the risk of thromboembolism is increased, the risk of anemia is decreased, the risk of endometrial cancer is decreased, and the severity of acne is decreased.
The Canadian OBGYN and Pediatrics guidelines support the advance provision of drugs and instructions for emergency contraception to sexually active women, so that they have ready access to them if they are needed.
The evidence shows that advance provision of emergency contraception:
A Cochrane review including randomized, controlled trials (RCTs) compared standard access to emergency contraception (EC) with advance provision. The review found eight trials, five of which were conducted. Two of the RCTs were sufficiently powered to show a difference in pregnancy rates. No study showed that giving advance EC reduced pregnancy rates on a population level. However, women who were provided with advance EC took the pills an average of approximately 15 hours sooner than women without advance access.
Five studies that reported on contraception use did not show a difference in type or frequency of regular contraception use among women who were provided advance EC. Women randomized to the advance EC groups were 2.5 times more likely to use EC once, and 4 times more likely to use it 2 or more times, compared to those without advance access.
Three studies reported rates of sexually transmitted infection and none found differences between the advance and standard access EC groups. Six studies reported rates of unprotected sexual intercourse and found no difference.
The Cochrane review concludes that advance access to EC appears to be safe, but does not reduce pregnancy on a population level. However, advance provision might be beneficial because it increases the speed and frequency of EC use.
Click to expand