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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