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Patient declines COVID swab


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Covering the UC and patient presents with abscess in left axilla...during intake her vitals are T 101.7, RR 22, HR 118, O2sat 88%.  We immediately put her on O2 and she had bilateral wheezing in lungs.  Immediately recommend patient go to ED but she refused, so I moved forward with chest XR which was concerning for bilateral lower lobe consolidation.  She continued to decline to go to the ED as she "needs to go with [her] daughter to a doctor's appointment on Monday."  I discussed the risks as she meets SIRS criteria with two potential sources of infection AND concerns for COVID AND everything else that is a concern.  Patient continued to decline ED and then even refused a COVID test because she "can't test positive because then [she] can't go with her daughter."

I am so angry right now and feel so helpless.  I'm concerned this patient will die, but that's her choice.  I've dealt with that before, and while it sucks it's her choice.  But, in the middle of a pandemic when she could be positive she is refusing a test and plans to continue to be out in the community!!!!

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11 minutes ago, mgriffiths said:

Covering the UC and patient presents with abscess in left axilla...during intake her vitals are T 101.7, RR 22, HR 118, O2sat 88%.  We immediately put her on O2 and she had bilateral wheezing in lungs.  Immediately recommend patient go to ED but she refused, so I moved forward with chest XR which was concerning for bilateral lower lobe consolidation.  She continued to decline to go to the ED as she "needs to go with [her] daughter to a doctor's appointment on Monday."  I discussed the risks as she meets SIRS criteria with two potential sources of infection AND concerns for COVID AND everything else that is a concern.  Patient continued to decline ED and then even refused a COVID test because she "can't test positive because then [she] can't go with her daughter."

I am so angry right now and feel so helpless.  I'm concerned this patient will die, but that's her choice.  I've dealt with that before, and while it sucks it's her choice.  But, in the middle of a pandemic when she could be positive she is refusing a test and plans to continue to be out in the community!!!!

Sorry MG, that's got to be rough. Would be ideal if this kind of thing could be reported to the health department...

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Only thing I might have done (which you could have, I dunno, you just didn't mention it) is call 9-1-1 and make her AMA not just from the UC, but from the medics too.  Not just for documentation, but out of a desire to 1) impress upon her the seriousness of the situation, and 2) have every available means to get her care immediately if she consents.

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20 minutes ago, rev ronin said:

Only thing I might have done (which you could have, I dunno, you just didn't mention it) is call 9-1-1 and make her AMA not just from the UC, but from the medics too.  Not just for documentation, but out of a desire to 1) impress upon her the seriousness of the situation, and 2) have every available means to get her care immediately if she consents.

Didn't think about that, will keep that in the back pocket...but hopefully I stop these shifts soon...just trying to get rid of these student loans.

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3 hours ago, ventana said:

Call 911.  Gets medics to get refusal.  
report to DPH
make them sign an ama that states they will isolate for 14 days. 
this is the only time I push really hard.  Usually if resp I talk about PE and death.  

Unfortunately she refused to sign anything and clearly stated she would not isolate as she needs to go with her daughter as I mentioned above.  I did report to local and state health departments, but both said there was nothing to do as we can't force her to do the test or to quarantine.  The only thing that I maybe should have done would have been to call EMS, but the patient would have been gone before they arrived anyway.

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I live in a high risk town.  Empty building right near my house offering covid-19 test.  Place was absolutely packed with cars police on site to keep traffic moving.  I'm betting none of them are sick; just want to be tested and you have a suspicious case and they refuse.  🙄. Vaccine can't get here soon enough.

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