MRCP2-3743
An 87-year-old man was admitted to the acute medical admissions unit due to acute confusion referred by his GP. The patient was prescribed trimethoprim 200mg BD for a presumed urinary tract infection three days ago, after his nursing home reported new urinary incontinence and offensive smelling urine. Unfortunately, his condition worsened, and he became confused and unable to mobilize, leading to the admission. The patient’s medical history included Alzheimer’s disease, hypertension, hypercholesterolemia, and osteoarthritis. He was taking donepezil 10 mg OD, amlodipine 5mg OD, atorvastatin 20mg ON, and paracetamol 1g QDS. The patient was usually able to mobilize independently and had intermittent confusion, but he could hold lucid conversations with his care workers. He had no lasting power of attorney or advanced directive in place, and his daughter, who resided abroad, had not contacted him in several years.
During the examination, the patient’s temperature was 39.6ºC, heart rate 122 bpm, respiratory rate 26/min, and blood pressure 97/58 mmHg. The cardiovascular system examination revealed a bounding peripheral pulse and a capillary refill time of three seconds. The respiratory system examination revealed tachypnea, and the abdominal examination revealed no abnormalities. The patient was not compliant with formal neurological examination, and his GCS was 14 (E4 S4 M6). He was very confused and unable to maintain a formal conversation, and his speech did not resemble any form.
When the doctor attempted to perform venous cannulation, the patient became very aggressive and hostile. He refused all forms of treatment, stating that he did not require medical treatment and requested to leave the ward immediately. The patient did not appear to comprehend the risks of refusing medical admission and was unable to recall the information disseminated.
What is the best course of action for managing this patient?