In head trauma with AMS and combative patient refusing treatment, which action is appropriate?

• A. Restrain and Treat
• B. Respect autonomy and do nothing
• C. Call the hospital and wait
• D. Document refusal and leave

Answer: (A)

In emergency head injury with altered mental status, the patient cannot give informed consent. That makes implied consent apply, so the priority is to provide life-saving treatment to stabilize airway, breathing, and circulation. If the patient is combative and may harm themselves or you, you may use the minimum necessary restraints to safely administer care and protect everyone involved while continuing assessment and treatment. You would explain what you’re doing as you go and monitor the patient, seeking medical direction as needed. Delaying care, waiting, or leaving the scene or documenting a refusal when the patient is not capable of consent would put the patient at risk, so those options aren’t appropriate.