Case for discussion

[dhb]

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So i was on call yesterday and i had this kind of interesting case.`
50 y/oldish women with intertrochanteric hip fracture. No relevant pmh, a couple of surgeries.
The problem is the patient refuses surgery and wants to be transferred to Germany. She has been seen by the psychiatrist who has deemed her incompetent (delirium/paranoia) and has involved a judge who has issued an order (don't know the legal terms) to treat her at our facility.

I see the patient in pre-op and she's coherent and refuses surgery restates she wants to be treated in Germany.
So i ask her details about the hospital in Germany and she comes up with a bogus name and adds it's some kind of new age bio something clinic. Social services had tried to elucidate this and didn't have more success

What's your next move?

edit: patient does not have an iv , she is in retrains although not agitated at this time

 

[Planktonmd]

What's your next move?

IM Ketamine, start IV, start Propofol infusion on your way to the OR, give GA.
Alternatively you could tell her that you have called the helicopter that will take her to Germany but she needs an IV for the trip, once the IV is in the conversation is over.

 

[epidural man]

IM Ketamine, start IV, start Propofol infusion on your way to the OR, give GA.
Alternatively you could tell her that you have called the helicopter that will take her to Germany but she needs an IV for the trip, once the IV is in the conversation is over.

Agree!

What did you do?

 

[dhb]

What Plank said , i swiftly gave 200mg Ketamine IM patient was like 😱 what are you doing. Waited five minutes then proceded to the OR where we induced GA.
Nothing very fancy but it wad just weird to take someone to the OR who is coherent and refuses surgery. You have to rely on the evaluation of the psychiatrist in one of the few areas we have no expertise.