11-29-2015, 03:17 AM
A 72-year-old woman is brought to the emergency department by her husband, who states, "She suddenly began having bad abdominal pain 12 hours ago. It has been hurting all over and this morning she had some bloody diarrhea." He adds that the patient was treated for an irregular heartbeat in the past. Vital signs are temperature 38.0°C (100.4°F), pulse 130/min and irregularly irregular, and blood pressure 96/60 mm Hg. The patient is confused, disoriented, and appears uncomfortable. Physical examination shows a rigid abdomen with absent bowel sounds and rebound tenderness in all quadrants. Rectal examination discloses no masses and no tenderness; stool tests positive for occult blood. After explaining the patient's diagnosis to her and her husband, you recommend proceeding with emergency laparotomy. The patient screams, "Don't cut on me, I want to go home." Which of the following is the most appropriate next step?
A) Admit the patient to the hospital for comfort measures only
B) Discharge the patient home C) Obtain administrative consent from the hospital administrator to proceed with the operation D) Obtain consent from the patient's husband to proceed with the operation E) Obtain psychiatric evaluation
A) Admit the patient to the hospital for comfort measures only
B) Discharge the patient home C) Obtain administrative consent from the hospital administrator to proceed with the operation D) Obtain consent from the patient's husband to proceed with the operation E) Obtain psychiatric evaluation