A 52-year-old man with schizophrenia and type 2 diabetes is brought to the emergency department with a foul-smelling, blackened right foot with purulent drainage and exposed bone. Medications are paliperidone palmitate IM monthly (last injection on schedule) and metformin PO; he has no known allergies. Blood glucose is 18.6 mmol/L (3.9-7.8), WBC 21.4 x10^9/L (4.0-11.0), lactate 3.1 mmol/L (0.5-2.2), and creatinine 96 umol/L (60-110). The surgical team recommends below-knee amputation, but the patient refuses, stating, "I would rather die than lose my leg." He is calm and oriented, with no hallucinations or disorganized speech on examination, and says he knows he may die without surgery. His sister is his designated substitute decision-maker.
| Heart rate | 112/min |
| Respiratory rate | 22/min |
| Temperature | 38.9 °C |
| O2 saturation | 95%, room air |
| Blood pressure | 104/62 mm Hg |
Question 1 of 29
Which of the following are the most appropriate steps to determine whether he is capable of refusing amputation?
Select 2. (0 / 2 selected)
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