grumpy reluctant elderly man with heart problems

[ellominero18]

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?

[DartmouthDave]

Hello,

Perhaps you could convince him to allow you to do a quick assessment. Vital signs and an EKG for example. Maybe then you he would consent to going to the hospital. Odds are he is a rational man who is angry or afraid because of his health issues. You may have a longer than average scene time but in the end I have found most people will come around.

However, if he says 'no' then it is time to go. As an adult he is allowed to make poor decisions.

If he becomes unconscious and there is no advanced directive present then his wife will become the 'substitute decision maker' and it will be her decision. Well, at least that is how it works in my area.

Cheers

[MariB]

The wife wanted him to go. So once he goes unresponsive, he is all yours

[island emt]

still looking for us to do your homework for you I see !

[HarryM]

As others have said, try and convince him to allow a quick ECG and taking of vitals and then if anything abnormal use that to try to convince him to come to hospital. Use his wife and call his GP and get them to try and convince him too. Then tell him he has a very high likelihood of dying today if he doesn't come to hospital. If that fails then document the shit out of it and leave him at home. He is competent to decline. If he goes unconscious then treat him as that is what the wife wants. If he had a fully written advanced directive and you can sight this then no treatment provided even if he does go unconscious.

[mobey]

Maybe it is time for one of our computer genius's to track down this guy's school and alert them of this issue.

[ERDoc]

I'm not sure if this is the same person, but someone with the same screen name has a long history of getting homework help. (yes, I really am that bored. It's a slow day at work)

http://answers.yahoo.com/activity;_ylt=Auw4WZewwyqITE9qs8Mo7XXsy6IX;_ylv=3?show=sZSV0gswaa&link=question#yan-questions-answers

http://www.chiefadvice.com/question/20100206103254AAc5pxj

[runswithneedles]

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?

Answer to question one: If hes A/Ox3 he has the right to refuse. Just be ready to respond to the adress again for a full code in a bit

Answer to question two: Try getting the wife to convince him to go. use any other family members present, ask him if you may take a look at him. if he does use non invasive diagnostic tools only (twelve lead, lung sounds, BP, spo2, and pulse). This sounds to me like a text book case of an MI. If my theory is correct and the twelve lead shows it you can use that as evidence to back up your suggestion to go the hospital

Answer to question 3: yes if he becomes unconscious check for pulse. if none present begin cpr, begin ACLS protocols, and request back up (we call out two additional medics while working a code) , if pulse is found go under implied consent, get a EKG, Iv established, secure airway if compromised, at the very least give Hi-con O2.

Answer to question 4: depends on what the advance directive states.

Edited July 17, 2013 by runswithneedles

[Happiness]

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?

So if you are trying to get us to do homework for you in creating these senario's at least write down what you would do and we may guide you on the right direction. No one wants a paramedic who has not done the work in class to pass and become a bad medic. just my thoughts.

[MariB]

OK needles, this is EMT class, so have to stop the 12 lead and the EKG lol