Epi-do
I see dead people
- 1,947
- 9
- 38
We were called for a sick person at Wal-Mart and show up to find an 86 yo sitting in a chair near the check-out. A bystander is with the patient, along with a couple Wal-Mart employees. The bystander states she was behind the patient in line when the patient "fainted" and the bystander caught them, lowering the patient to the ground. The bystander stated it took a couple seconds before the patient "woke up" and started talking again.
The patient states they feel "fine" and that similar episodes have happened "when I shop too long, or stand in one place for too long." BP was 160/100, Pulse 72, and respiratory rate of 14. Skin is warm, pink, and dry. The patient states they were short of breath and dizzy immediately prior to the syncopal episode. The patient apologizes for 911 being called and states they do not wish to go to the hospital for evaluation.
I ask the patient if we could go out to the ambulance so I can hook up the cardiac monitor and see if anything appears to be going on with their heart and the patient refuses, stating once again that this happens "all the time" and that it is "normal." Outside of allowing the initial BP and pulse, the patient refuses all other medical care.
I explain to the patient that I am concerned there may be something going on with their heart, that it isn't "normal" to "just pass out," or to be short of breath simply due to standing in one place "too long." The patient still refuses to allow me to check them out any further. I then explain the associated risks given the symptoms they are having. The patient informs me that due to having a stent placed 5-6 years ago, they go every summer to the cardiologist for a check up and stress test and at their last appointment (last summer) everything checked out ok.
I explained to the patient that while I couldn't force her to go to the ER with me, I was not comfortable at all with letting her sign a refusal of transport, and that given the circimstances I needed to call the hospital and talk to the doctor before going over paperwork with her. I get a doc online and give a brief report of the episode and state the patient is not wanting to be transported. The doc basically says the same things I told the patient - that she really needs to be seen in the ER, that she could be having some sort of cardiac episode, and further episodes could result in disability or death. He also advised me that he was denying my request for and SOR (which I knew would happen).
At that point, the patient states they understand everything the doctor has said, that they will call their cardiologist when they get home, and that they really are "fine" and don't need to go to the ER. The doc reiterated their recommendation and the patient continued to refuse transport.
The patient's PMHx included a stent placed 5-6 years ago, as well as heart disease, and pulmonary issues. She did not have anyone with her that could drive her home, nor did she have a cell phone or anyone that could come pick her up if we called them. The patient signed the refusal and I then documented the heck out of it on the run report.
Short of kidnapping this patient, I couldn't think of any other approaches to try and get them to go to the ER. Most of the time, if I can get them into the ambulance I can get them to agree to transport, but she wanted no part of that. I also explained the risks to her, and then had her talk to the doc, who also explained the risks to her of not going to the ER.
My question is, is there any other approach I could have used to try and get her to go with me? General consensus around the firehouse is that I did all I could do, and that the SOR was very well written. (I had those on station that weren't on the run read the report for me and let me know if they had any questions about what happened. They all said it was very clear how the run had went.)
I know at 86, alot of people are set in their ways and you aren't going to convince them of anything they do not want to do. I know I did a good job with my documentation of the run, and that I provided as much care as the patient would allow me to provide. I am just looking to add to my options when it comes to convincing a patient to go to the hospital and thought some of you may have some ideas that I did not think of.
The patient states they feel "fine" and that similar episodes have happened "when I shop too long, or stand in one place for too long." BP was 160/100, Pulse 72, and respiratory rate of 14. Skin is warm, pink, and dry. The patient states they were short of breath and dizzy immediately prior to the syncopal episode. The patient apologizes for 911 being called and states they do not wish to go to the hospital for evaluation.
I ask the patient if we could go out to the ambulance so I can hook up the cardiac monitor and see if anything appears to be going on with their heart and the patient refuses, stating once again that this happens "all the time" and that it is "normal." Outside of allowing the initial BP and pulse, the patient refuses all other medical care.
I explain to the patient that I am concerned there may be something going on with their heart, that it isn't "normal" to "just pass out," or to be short of breath simply due to standing in one place "too long." The patient still refuses to allow me to check them out any further. I then explain the associated risks given the symptoms they are having. The patient informs me that due to having a stent placed 5-6 years ago, they go every summer to the cardiologist for a check up and stress test and at their last appointment (last summer) everything checked out ok.
I explained to the patient that while I couldn't force her to go to the ER with me, I was not comfortable at all with letting her sign a refusal of transport, and that given the circimstances I needed to call the hospital and talk to the doctor before going over paperwork with her. I get a doc online and give a brief report of the episode and state the patient is not wanting to be transported. The doc basically says the same things I told the patient - that she really needs to be seen in the ER, that she could be having some sort of cardiac episode, and further episodes could result in disability or death. He also advised me that he was denying my request for and SOR (which I knew would happen).
At that point, the patient states they understand everything the doctor has said, that they will call their cardiologist when they get home, and that they really are "fine" and don't need to go to the ER. The doc reiterated their recommendation and the patient continued to refuse transport.
The patient's PMHx included a stent placed 5-6 years ago, as well as heart disease, and pulmonary issues. She did not have anyone with her that could drive her home, nor did she have a cell phone or anyone that could come pick her up if we called them. The patient signed the refusal and I then documented the heck out of it on the run report.
Short of kidnapping this patient, I couldn't think of any other approaches to try and get them to go to the ER. Most of the time, if I can get them into the ambulance I can get them to agree to transport, but she wanted no part of that. I also explained the risks to her, and then had her talk to the doc, who also explained the risks to her of not going to the ER.
My question is, is there any other approach I could have used to try and get her to go with me? General consensus around the firehouse is that I did all I could do, and that the SOR was very well written. (I had those on station that weren't on the run read the report for me and let me know if they had any questions about what happened. They all said it was very clear how the run had went.)
I know at 86, alot of people are set in their ways and you aren't going to convince them of anything they do not want to do. I know I did a good job with my documentation of the run, and that I provided as much care as the patient would allow me to provide. I am just looking to add to my options when it comes to convincing a patient to go to the hospital and thought some of you may have some ideas that I did not think of.