4 ms·

I'm in a similar position on a fairly regular basis, and I can tall you that DNRs absolutely do matter. It would take the threat of physical violence to get me

I'm in a similar position on a fairly regular basis, and I can tall you that DNRs absolutely do matter. It would take the threat of physical violence to get me to perform ACLS on someone with a valid DNR (this is in a prehospital EMS setting). A DNR represents the expressed wishes of the patient. Disregarding that is a serious breach of medical this. I'm not sure how often she came across that particular dilemma. As a nurse in an ICU she would have limited decision making authority when it comes to initiating and continuing things like ACLS[1]. That's a doctor's call. I will say that in my experience as a prehospital EMS provider, I absolutely honor the wishes of the patient (as expressed in a DNR) over the demands of the family. In fact, in my experience, the issue that arises is exactly the opposite. The family doesn't want CPR, etc, and states the patient has a DNR, but they're unable to produce it (hence my original post). In the absence of a valid DNR, I have to assume the person _does_ want all resuscitation measures attempted. [1] http://en.wikipedia.org/wiki/Advanced_cardiac_life_support http://en.wikipedia.org/wiki/Advanced_cardiac_life_support

gohrt 13y ago
As a pre-hospital EMS provider, how do you have time to determine the presence and validity of a DNR before making your choice?
- JshWright 13y ago
  It's pretty simple... is there a DNR in my hand that hasn't expired and has been signed by both the patient and a doctor and hasn't expired? If yes, then don't initiate resuscitation. Obviously a DNR could be forged, but baring obvious cases of forgery (which I've never seen), we're not liable for honoring a DNR that we reasonably believe is valid.
  - jlgaddis 13y ago
    What about a "verbal DNR"? I was recently involved in a pretty bad motorcycle accident and was asked multiple times (by EMS on the scene, medical staff in the ER, medical staff right before going into the OR, etc.) if I had a DNR and/or if I would want them to attempt to save me if something happened. I remember thinking that was kinda weird since my assumption was that such requests would need to be in writing. Perhaps it was because I was incapable of writing or signing my name, though (two broken wrists)? Instead of me signing any documents, they just asked me verbally after making sure they had two other employees present as witnesses.
    - JshWright 13y ago
      That's actually _better_ than a written document as far as I'm concerned. A DNR basically says "If I'm unable to speak for myself, here's how I would like to be treated." If you _are_ able to tell me how you want to be treated, then there's no question (assuming I'm confident in your ability to make informed decisions... not drunk off your ass... etc...)
- FireBeyond 13y ago
  In addition to what Josh says, in ambiguous situations, we will begin CPR or other life-saving measures whilst efforts are made to obtain/ascertain. We can always discontinue these efforts - on the other hand, delayed starts of such measures are more likely (if they result in survival at all) to end up with exactly the kinds of situations described here, brain damage, serious side effects, and the like.
jlgaddis 13y ago
> I'm not sure how often she came across that particular dilemma. Not very often -- AIUI she spent most of her time "freezing" patients (inducing hypothermia). Somehow we got on the subject of DNRs and she explained their policy/reasoning to me. Basically, if a patient w/ a DNR "coded" and a family member was yelling to save them, they would.
- JshWright 13y ago
  That's really lousy of them... A patient's wishes supersedes those of their family, when it comes to their care and end of life decisions. That really lousy of the families... of the providers... of everyone all around, really. I would absolutely refuse to participate in resuscitation efforts in that situation. I'm hopeful that if that situation actually came up, they would decide differently (and that this was just a hypothetical conversation)

gohrt 13y ago

As a pre-hospital EMS provider, how do you have time to determine the presence and validity of a DNR before making your choice?

JshWright 13y ago
It's pretty simple... is there a DNR in my hand that hasn't expired and has been signed by both the patient and a doctor and hasn't expired? If yes, then don't initiate resuscitation. Obviously a DNR could be forged, but baring obvious cases of forgery (which I've never seen), we're not liable for honoring a DNR that we reasonably believe is valid.
- jlgaddis 13y ago
  What about a "verbal DNR"? I was recently involved in a pretty bad motorcycle accident and was asked multiple times (by EMS on the scene, medical staff in the ER, medical staff right before going into the OR, etc.) if I had a DNR and/or if I would want them to attempt to save me if something happened. I remember thinking that was kinda weird since my assumption was that such requests would need to be in writing. Perhaps it was because I was incapable of writing or signing my name, though (two broken wrists)? Instead of me signing any documents, they just asked me verbally after making sure they had two other employees present as witnesses.
  - JshWright 13y ago
    That's actually _better_ than a written document as far as I'm concerned. A DNR basically says "If I'm unable to speak for myself, here's how I would like to be treated." If you _are_ able to tell me how you want to be treated, then there's no question (assuming I'm confident in your ability to make informed decisions... not drunk off your ass... etc...)
FireBeyond 13y ago
In addition to what Josh says, in ambiguous situations, we will begin CPR or other life-saving measures whilst efforts are made to obtain/ascertain. We can always discontinue these efforts - on the other hand, delayed starts of such measures are more likely (if they result in survival at all) to end up with exactly the kinds of situations described here, brain damage, serious side effects, and the like.

jlgaddis 13y ago

> I'm not sure how often she came across that particular dilemma. Not very often -- AIUI she spent most of her time "freezing" patients (inducing hypothermia). Somehow we got on the subject of DNRs and she explained their policy/reasoning to me. Basically, if a patient w/ a DNR "coded" and a family member was yelling to save them, they would.

JshWright 13y ago
That's really lousy of them... A patient's wishes supersedes those of their family, when it comes to their care and end of life decisions. That really lousy of the families... of the providers... of everyone all around, really. I would absolutely refuse to participate in resuscitation efforts in that situation. I'm hopeful that if that situation actually came up, they would decide differently (and that this was just a hypothetical conversation)