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A discussion in another thread as well as a discussion I had with my last trainee and another coworker gave me the idea for this thread. I will give you my opinion on the matter after others have chimed in.
You're on scene of a patient who is awake, alert, oriented, ambulatory, not intoxicated, very capable of caring for themselves, not suicidal/homicidal and is able to understand and reiterate everything that is explained to them including the gravity of their situation, the risks associated with refusing care and transport and instructions that are provided to them. There is a witness on scene who is competent as well and signs the AMA form as a witness.
This theoretical patient is having chest pain and either they called or a family member called, doesn't really matter.
The 12-lead shows a massive anterior STEMI, their vitals are not terrible but trending towards hemodynamic instability. You explain everything to the patient and tell them they need to go to the hospital for emergent PCI however they adamantly refuse stating "if it's my time it's my time." They do not want to go with you or POV and adamantly state they do not want medical attention of any kind and do not want to be resuscitated however they do not have a signed DNR or POLST.
As you're leaving you hear a thud and turn around to see the patient ago all on the living room floor. You check and they are pulseless. Can you treat this patient? They're unresponsive now so implied consent seems like it's cut and dry however it's the same condition you were just assessing them for that cause the cardiac arrest and when they were fully capable of making decisions they adamantly refused treatment and transport and acknowledged the fact that this may very well kill them. They stated they do not want to be resuscitated and do not want any help.
Tell me what you think, keep it civil and support your answers with why not just "mongo do this!" Ready, set, GO!
You're on scene of a patient who is awake, alert, oriented, ambulatory, not intoxicated, very capable of caring for themselves, not suicidal/homicidal and is able to understand and reiterate everything that is explained to them including the gravity of their situation, the risks associated with refusing care and transport and instructions that are provided to them. There is a witness on scene who is competent as well and signs the AMA form as a witness.
This theoretical patient is having chest pain and either they called or a family member called, doesn't really matter.
The 12-lead shows a massive anterior STEMI, their vitals are not terrible but trending towards hemodynamic instability. You explain everything to the patient and tell them they need to go to the hospital for emergent PCI however they adamantly refuse stating "if it's my time it's my time." They do not want to go with you or POV and adamantly state they do not want medical attention of any kind and do not want to be resuscitated however they do not have a signed DNR or POLST.
As you're leaving you hear a thud and turn around to see the patient ago all on the living room floor. You check and they are pulseless. Can you treat this patient? They're unresponsive now so implied consent seems like it's cut and dry however it's the same condition you were just assessing them for that cause the cardiac arrest and when they were fully capable of making decisions they adamantly refused treatment and transport and acknowledged the fact that this may very well kill them. They stated they do not want to be resuscitated and do not want any help.
Tell me what you think, keep it civil and support your answers with why not just "mongo do this!" Ready, set, GO!