Dissecting aneurysm of thoracic aorta with acute EKG changes.

Jehovah Witness bled out in surgery. Hgb 3.9 even with cell saver device. Researched hospital that deals with patients who refuses blood transfusion. Contacted John Hopkins Medical center and spoke with hematologist who shared a protocol that we followed. It took around 10 days but finally she achieved 7.5.

As an LMHC I do remote telehealth therapy through the 988 service in Florida. I had been working with a patient for few weeks who was going through a divorce and had been laid off from a company they had been with for over a decade. This was occurring during the holiday season, and this particular session was the week of Thanksgiving. The patient was depressed and had been having suicidal thoughts, though they had some protective factors. In this session the patient was suicidal and had the means and plan. I was in completely different city far from the client. While I kept the patient engaged I looked in ERT in their area, and verified the emergency contact of this middle aged patient. Once I made it clear that I felt they needed to go to the inpatient clinic to be evaluated they became very angry and verbally abusive toward me. However, I knew the Emer contact was in the home with patient. I called and explained the situation when patient disconnected our call. Together we had the patient contact the ERT and I also did-and explained that if the patient did not make this contact as well I would have to Baker Act. I was completing the paperwork simultaneously. The ERT made contact and went to the patient home. They spoke to me while with the patient, removed all methods available and had a friend of patient come to keep those items safe. Although the patient did not go to the hospital that day, the ERT had me schedule another session for 2 days later. And at that time, the patient was in the car with their friend headed to the hospital. The patient remained for 2 weeks and when discharged was provided a diagnosis and medication and reached out to thank me for saving their life and for insisting they get inpatient treatment. Now several months later, when they were contacted for feedback by ERT agency, the testimonial they gave later was recorded and used for marketing-because the patient was so pleased with the help they got. Now the patient is employed and actually working on the marriage and is much happier in general!