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You arrive on scene to find an elderly gentleman sitting in his recliner. He is obviously disturbed that you are here. He says that his wife called you after he told her not to. When you talk with the gentleman, you find that he is having a significant amount of chest pain that radiates down his left arm and into his jaw. He says that he is tired of hospitals and does not want you to do anything for him. He tells you that he has a long history of heart problems and was recently told he needed a heart transplant. You try to convince the man to let you transport him to the hospital for treatment, but he continues to refuse care. You ask him and his wife if he has some form of advanced directive there at home, and they tell you that "the doctor is working on it but has not sent it home yet." WHAT DO YOU DO? · What options do you have? · Is there anything you can say or do to convince the patient to go to the hospital? · What if he becomes unconscious before you leave; will your approach change then? · Would your approach be any different if the patient had a valid advance directive present?

This is gonna be a little different than a normal scenario, as I do not have the final diagnosis. I just thought this was an interesting case, and it was fun going through the differential diagnosis. A 16y/o 155lb male was shoveling a bin of old oats at 1400hrs. There was some mould in the bin, as well as rats/mice. He was not wearing a mask. At 1800hrs he had sudden onset pleuritis and SOB. His mother gave him an advil (500mg) and told him to lay down. At 1830 the pleuritis became worse (9/10) and he was notably tachypneic due to splinting his breathing. He was quite lethargic and generally weak. His mother brought him to the ER: HR: 140 BP 90/42 Temp 39.8 RR 36 Sp02 98% room air Skin diaphoretic & flushed A&O X4 9/10 chest pain midsternal nonradiating pleuritic in nature. Auscltation= quiet on the left, but clear. Right apex clear but some crackles noted in the base. Overall, very hard to hear bases as patient will not take full breaths. Pt was given 1G Tylenol, and fever was gone within 30min. A 500ml bolus was administered and vitals changed to: HR 110 BP 100/44 Temp 36.4 RR 36 Sp02 98% What would you do for this patient? What kind of hospital would be most approprate? Differential Diagnosis?