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Emergency limb amputation
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56 y.o. male with hx HTN, DM presented over weekend with infected foot and crepitus in the calf. AAOx3, BP 98/57; HR 91; Fs 347, WBC 21. Surgeon wanted to do BKA but patient refused stating that he used to be soccer player and just needs treatment for the skin condition (ABX). If surgery is required he would rather be discharged home and he will discuss his condition with his friends and church friends. Anyway "Everything is in the God's hands". Psychiatry was consulted about decision capacity. Risk management was contacted and advised to proceed if it is considered medical emergency. Over the course of 8 hours despite treatment pt become hypotensive (SBP 80), Lactate increased from 2.4 to 7.8 and mental status became clouded. He was brought to OR where he was noted to be bradycardic, nonverbal and with poorly palpable pulse. Was intubated and fluid/pressor resuscitation started. ABG on ventilator was 7.04/38/427/10/-20.
I did not see the patient until OR and did not have anesthesia consent. Patient had neither family nor health care proxy available. Would you proceed with BKA or limit resuscitation to conservative measures?
Tags
treatment refusal, decision capacity, curbside
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