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Suggest Treatment For Blood In Vomit And Lower Blood Count
Question: My 78 y/o father was released this morning from the hospital.
Tuesday morning, he was taken to the ER because he was vomiting blood. Blood was taken for FBC. They also took his BP in several different positions. All was fine until he stood and his pressure fell to 70/40. This result, and the fact his blood count was found to be 7.5, and not the 11 it was a week or so ago, they admitted him.
An Endoscopy was performed later in the day and two ulcers were found. The ulcer located just at the beginning of the large intestine was 4cm long. It was found bleeding and catheterized then. The second ulcer was found on his esophagus and was not bleeding. He was given fluids all day and evening.
Wednesday morning he continued to suffer from low blood pressure readings and his RBC had fallen again to 7.0. Two units of blood were ordered and he stayed admitted again overnight.
Thursday morning his blood pressure was better and his RBC was higher but again they chose to keep him overnight again to see if his vitals might improve more before going home.
Today he was released and sent home even though his RBC had fallen again. Knowing my father is in the beginning stages of Alzheimer's, and he's been raising XXXXXXX wanting to go home, would you have sent him home?
Tuesday morning, he was taken to the ER because he was vomiting blood. Blood was taken for FBC. They also took his BP in several different positions. All was fine until he stood and his pressure fell to 70/40. This result, and the fact his blood count was found to be 7.5, and not the 11 it was a week or so ago, they admitted him.
An Endoscopy was performed later in the day and two ulcers were found. The ulcer located just at the beginning of the large intestine was 4cm long. It was found bleeding and catheterized then. The second ulcer was found on his esophagus and was not bleeding. He was given fluids all day and evening.
Wednesday morning he continued to suffer from low blood pressure readings and his RBC had fallen again to 7.0. Two units of blood were ordered and he stayed admitted again overnight.
Thursday morning his blood pressure was better and his RBC was higher but again they chose to keep him overnight again to see if his vitals might improve more before going home.
Today he was released and sent home even though his RBC had fallen again. Knowing my father is in the beginning stages of Alzheimer's, and he's been raising XXXXXXX wanting to go home, would you have sent him home?
Brief Answer:
Probably kept him in hospital
Detailed Answer:
Hi, thank you for using Healthcare Magic. If your father's RBCs were still falling, I probably would have continued to observe him in the hospital another day or two. This could be a sign that some bleeding was still going on.
That being said, it is difficult to keep a patient in the hospital against his will, and is actually illegal if the patient is considered competent. Even if your father has early Alzheimers, if he has not been declared legally incompetent, he can choose to leave no matter how sick he is, and no one can prevent him. This is called "discharge against medical advice."
It is unfortunate that even when you know what's in the best interests of the patient and that he may not be thinking clearly due to dementia, legally you cannot do anything. Keeping him against his will would be considered a form of assault or even kidnapping.
The best thing to do now is to keep a close eye on him, and if he develops further problems, get him back to the hospital right away. Hope this answers your query. If you have further questions, I would be happy to answer them.
Probably kept him in hospital
Detailed Answer:
Hi, thank you for using Healthcare Magic. If your father's RBCs were still falling, I probably would have continued to observe him in the hospital another day or two. This could be a sign that some bleeding was still going on.
That being said, it is difficult to keep a patient in the hospital against his will, and is actually illegal if the patient is considered competent. Even if your father has early Alzheimers, if he has not been declared legally incompetent, he can choose to leave no matter how sick he is, and no one can prevent him. This is called "discharge against medical advice."
It is unfortunate that even when you know what's in the best interests of the patient and that he may not be thinking clearly due to dementia, legally you cannot do anything. Keeping him against his will would be considered a form of assault or even kidnapping.
The best thing to do now is to keep a close eye on him, and if he develops further problems, get him back to the hospital right away. Hope this answers your query. If you have further questions, I would be happy to answer them.
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Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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