Question

72 yo M is hospitalized for the 3rd time in 3 months for SOB. He has stage III, end stage COPD, NYHA class III heart failure. No advance directive and the resuscitation preference most recently noted from a visit 6 months ago is full code. Most appropriate management?

Answer 1

The most appropriate management for a patient with end-stage COPD and NYHA class III heart failure would be to re-evaluate the patient's resuscitation status and have a discussion about goals of care, including palliative care options and an advance directive.

Step-by-step explanation:

The question seems to describe a patient with severe chronic obstructive pulmonary disease (COPD) and class III heart failure who has been hospitalized multiple times for shortness of breath and does not have an advance directive. The most appropriate management would involve re-evaluating the patient's resuscitation status in light of his current health status and likely prognosis. It is essential to engage in a goals-of-care discussion with the patient and his family, considering the option of palliative care and the possibility of creating an advance directive that aligns with his current health situation and wishes.

Conditions like COPD, heart failure, and frequent hospitalizations emphasize the need for careful planning around end-of-life care and the establishment of clear treatment goals, which may include non-invasive supportive measures or a focus on quality of life rather than aggressive interventions that may not provide substantial benefit.