Notes

cardiorespiratory arrest. This patient was evaluated today at ER with complaint of shortness of breath, respiratory distress, mild effort dyspnea and fatigue secondary to an acute exacerbation of chronic idiopathic pulmonary fibrosis since 3 days, condition of which he refuse to take medication at home to avoid side effects and damaging internal organs as he said. After proper medical evaluation case was consulted with Internal Medicine Dr Abreu for admission consideration due to several altered laboratory that need urgent correction among which are Hypoxemia, Hyperchromia, Hyponatremia, Hypochloremia, Elevated BNP, Lower Limb Edema and Dehydration. Beside explaining patient his deteriorate clinical picture and need for consultation and admission patient decide to abandon ER. He state he have to and will visit his Pneumologist tomorrow. Possible and highly probable consequence of his premature leaving was explained to both patient and wife including risk of respiratory arrest, cardiac arrest and death, both acknowledge understanding, nevertheless he insist in his already final decision of leaving ER and sign exoneration against medical advice. Both patient and wife thanks all ER personal for the given attention and walk outside. Still outside of ER waiting room, waiting for his wife car to arrive, patient underwent increased respiratory distress, slip down to floor - knee first then face down - with facial cyanosis, and pulseless respiratory arrest. ER Personnel rush to patient location after been notify by witness patients on waiting room, CPR started onsite, rise patient to stretcher and transport immediately to Critical Care Unit with ongoing CPR, where ALCS was successfully completed with patient intubation.