A 79-year-old man with significant comorbidities (ischaemic heart disease, diabetes, peripheral vascular disease) was admitted to hospital with anorexia and weight loss. He developed acute confusion and delirium, initially refusing vascular intervention for gangrenous toes. He was detained under mental health legislation due to acute delirium and lack insight. Chest pain developed, indicating acute myocardial infarction. On the day of death, a MET call identified extensive acute MI. Given his age, comorbidities, poor prognosis, and refusal of invasive treatment, a palliative approach was agreed with his close friend. The coroner found treatment was of extremely high standard with appropriate clinical decision-making, though noted inadequate documentation of the 'not for resuscitation' decision and Dr L.'s unfamiliarity with relevant hospital protocol.
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Specialties
cardiologypsychiatryvascular surgerygeneral medicineemergency medicine
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