Let him go.
Inform GP.
Try and get family member on his side.
Put a clinic appointment in his pocket for the next day.
Tell him he's an idiot - (well I'd like to!)
Simon Carley
Anaesthetics / Intensive Care
Stepping Hill Hospital
Stockport
England
[log in to unmask]
----------
> From: Danny McGeehan <[log in to unmask]>
> To: Watson, David <[log in to unmask]>; Simon Carley
<[log in to unmask]>; Rowland Cottingham <[log in to unmask]>;
Patrick K. Plunkett <[log in to unmask]>; Nick Macartney
<[log in to unmask]>; Lawrence H Jaffey <[log in to unmask]>; John Ryan
<[log in to unmask]>; [log in to unmask]; Carlos Perez Avila
<[log in to unmask]>; Bill Hulse <[log in to unmask]>; Andy Newton
<[log in to unmask]>; Andrew G Hobart <[log in to unmask]>;
Alain Vadeboncoeur <[log in to unmask]>; [log in to unmask]
> Subject: What would you have done
> Date: 28 September 1998 16:17
>
> Hi all
> Familiar scenario last Saturday night. Dept. like a madhouse and patient
> arrives on the "999"'s c/o SOB. Vital signs and O2 saturation normal.
> However has decreased air entry right side and CXR shows a complete
> pneumothorax on the right side.
> ABGs show normal CO2 but O2 decreased at just over 10 kpascals on room
air.
> Explained to patient that needs a intercostal drain as a probable
potential
> life saving procedure. He adamantly refuses to stay in hospital.
Patient
> counseled with wife and patiently explained that he could tension,
develop
> V/Q mismatch and in lay language severity of condition explained.
> In spite of efforts of senior medical and nursing staff he signs his own
> discharge and insists on leaving the department. Although at the lower
end
> of the standard distribution curve for IQ, he is not confused.
> What would you do?
> Danny McGeehan MB FRCS FFAEM
>
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