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Lifesaver98

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18 y/o female who crashed her bike. She doesn't remember the event. She complains of neck pain and headaches. 3/10. Her helmet appears to be undamaged. She doesn't know exact date but knows the month. Does not know the time of day either. Her heart rate is elevated along with respiratory rate. He bp is low. She has a few minor scrapes and is a little sore. She claims she is ok and wants to refuse treatment. How would you proceed?

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Here's my $0.02.

While a BGL is necessary, the next of kin/responsible party is irrelevant. The pt is 18, which means she has to make the decision for herself.

That being said, I'm not necessarily concerned about the elevated pulse & respiration rates. She was just biking, of course she's going to be elevated. Along that thought process, chances are she may also be an avid cyclist/athlete, which means she may have a low BP normally. Now, while the lack of memory for the event as well as date/time is concerning, we cycle (see what I did there? ;) ) back to the necessity for a BGL.

Now for the heart of the matter: Do we allow this pt to refuse tx & xport? This is where you need to do a really good focused H&P on the pt. Find out if those vitals are normal, if she has any known medical issues, etc. After performing that H&P, if everything checks out..we can start down the refusal pathway, whereas if there are issues found, things would need to take a different turn. If after everything we do & find, she still wants to refuse, it is still ultimately her decision. So here's what we do: explain the risks of refusal (possibility of unseen/UNK injuries & explain that the possibility that there is a chance those injuries could lead to more serious events [to coin the phrase: SZ, coma, death]). My next move would be to explain that I work under a MD's license, & I would need to contact him/her to explain the situation, & that I would express to that MD the pt's wishes to refuse tx & xport. If my MD is ok with the pt refusing, then by all means she can, but if not - I would need to xport the pt.

Given the above, if the pt is allowed to refuse: I would explain that refusing right now does NOT mean that tx &/or xport can't be sought later. I would HIGHLY encourage the pt to seek further medical tx on her own, or contact EMS if her S/Sx change or worsen. One thing I would explain to the pt is that at the moment, she still has a lot of adrenaline pumping through her system due to the events & that once that adrenaline wears off, she's likely to experience increased pn or other S/Sx, which would then be an indication of the need for further medical tx. After that point, I would ensure that the pt signs my refusal form, as well as grab a witness (non-family, non-EMS) signature if possible.

So what do we take away from this? The bigger question in this scenario is: What caused the pt to crash on her bike? Was it an underlying problem such as a low BGL, or did the memory lapse come after the event? The biggest assistance we can provide as EMS professionals is not getting sidetracked by surface level problems; we MUST dig deep, think critically, & be all inclusive in our exams & tx's.

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On ‎9‎/‎5‎/‎2016 at 2:25 PM, SWA_EMT said:

Here's my $0.02.

While a BGL is necessary, the next of kin/responsible party is irrelevant. The pt is 18, which means she has to make the decision for herself.

That being said, I'm not necessarily concerned about the elevated pulse & respiration rates. She was just biking, of course she's going to be elevated. Along that thought process, chances are she may also be an avid cyclist/athlete, which means she may have a low BP normally. Now, while the lack of memory for the event as well as date/time is concerning, we cycle (see what I did there? ;) ) back to the necessity for a BGL.

Now for the heart of the matter: Do we allow this pt to refuse tx & xport? This is where you need to do a really good focused H&P on the pt. Find out if those vitals are normal, if she has any known medical issues, etc. After performing that H&P, if everything checks out..we can start down the refusal pathway, whereas if there are issues found, things would need to take a different turn. If after everything we do & find, she still wants to refuse, it is still ultimately her decision. So here's what we do: explain the risks of refusal (possibility of unseen/UNK injuries & explain that the possibility that there is a chance those injuries could lead to more serious events [to coin the phrase: SZ, coma, death]). My next move would be to explain that I work under a MD's license, & I would need to contact him/her to explain the situation, & that I would express to that MD the pt's wishes to refuse tx & xport. If my MD is ok with the pt refusing, then by all means she can, but if not - I would need to xport the pt.

Given the above, if the pt is allowed to refuse: I would explain that refusing right now does NOT mean that tx &/or xport can't be sought later. I would HIGHLY encourage the pt to seek further medical tx on her own, or contact EMS if her S/Sx change or worsen. One thing I would explain to the pt is that at the moment, she still has a lot of adrenaline pumping through her system due to the events & that once that adrenaline wears off, she's likely to experience increased pn or other S/Sx, which would then be an indication of the need for further medical tx. After that point, I would ensure that the pt signs my refusal form, as well as grab a witness (non-family, non-EMS) signature if possible.

So what do we take away from this? The bigger question in this scenario is: What caused the pt to crash on her bike? Was it an underlying problem such as a low BGL, or did the memory lapse come after the event? The biggest assistance we can provide as EMS professionals is not getting sidetracked by surface level problems; we MUST dig deep, think critically, & be all inclusive in our exams & tx's.

So you do your due diligence and find exactly what the OP describes....a disoriented 18 year old with a bike and some scrapes that wants to refuse care. And a normal blood sugar.

The real danger here is making it way more complicated than it is. Given this set of circumstances, she can't be left alone. So, finding a responsible next of kin/party (roommate, boyfriend, parent etc) can ensure she gets potentially life saving care by familiar and friendly encouragement to seek attention. At the very least, she might go to the hospital with that person. It would also avoid getting the cops involved.

Based solely on what the information given is, leaving her alone is the wrong answer.

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