Carlos
>From your description he had a reduced GCS (maybe less than 14 as he was
resisting a collar etc -- did he have a more depressed LOC than you thought?),
he was tachycardic, hypoxic, hypercapnic. He had multiple rib fractures,
pulmonary contusion and a fractured pelvis.
I would suspect he could only get worse without full supportive treatment ie
intubation and ventilation plus other indicated treatment.
The history of COPD makes this a difficult decision as its hard to wean them
off the ventilator.
Also are you looking for a reply because of his age? If so, I think it would
be difficult to refuse to treat adequately unless the full history is
available including talking to relatives etc For instance if he were endstage
COPD , just discharged last week on domiciliary oxygen, with Ca mets and a
decision of DNR it would be reasonable to keep comfortable provided the
relatives agree. If this sort of history is not forthcoming then I would feel
obliged to give him the full support he needs for his injury.
However, I'm sure you're going to tell us you kept him comforatble and he went
home the next day!!.
Regards
Graham
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