In message <[log in to unmask]>, Barry Salkin
<[log in to unmask]> writes
>>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?
Was he drunk?
If so, there might be a case for saying he's not sufficiently competent
to make informed decisions about his best treatment. You could then
safely invoke common law and forcibly treat him if he had a life-
threatening condition. I'm not saying that's the best thing to do and I
certainly would not rush to do this myself (it would be hard to see how
you could put a drain in someone without their co-operation, or a GA). I
merely throw it in for completeness, in view of some of the other
comments that have been made about the legal aspects.
===========================================================================
Goat
(e-mail: [log in to unmask])
Sussex, U.K.
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To err is human, to forgive is not management policy
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