I posted this in Konata88’s thread, but actually I consider it so important I want to raise the visibility of it. It’s troubled me for twenty years, ever since California decided EVERY PERSON ADMITTED TO THE HOSPITAL NEEDS TO DECIDE IF THEY WANT A DNR ORDER. This is a catastrophe waiting to happen.

Let me explain something to all you civilians:

Your idea of what DNR means and what physicians and nurses think it means are very different.

Your idea is, I’m brain dead, everyone knows it, don’t do anything like shocking my heart to try bringing me back. That’s what we ALL want. We don’t want to be a burden on our family.

What the medical community understands is: he has had a cardiac arrest due to ventricular tachycardia; this is eminently treatable with a simple shock, he’s only been down a couple of minutes, he should come back good as new. But he has a DNR order, so we legally can’t shock him. Sorry, fella!

I’m thinking of getting a tattoo on my chest: DON’T STOP UNTIL I’M CHARCOAL!
Well, just kidding about that.

But please, do not repeat NOT hamper your survival from a heart attack or cardiac arrest by having a visible wristband, tab, notation on your iPhone or whatever that says “DO NOT RESUSCITATE” unless you are terminally ill or age 100 and tired of the hassle.

I have seen this in real life: someone comes in the hospital for a minor procedure. The residents admitting in California are REQUIRED BY LAW to ask if the patient wants to be resuscitated in case of cardiac arrest. I’ve seen patients in for a cardiac cath who said yes to DNR. If the patient had a treatable but potentially fatal heart rhythm—which is NOT uncommon—I would legally have had to let them die. Fortunately I clued in the nurse practitioners what to do: an exception is made for a medical/cardiac procedure.

ONCE AGAIN: WHAT YOU THINK IS GOING TO HAPPEN AND WHAT THE DOCTORS/NURSES/EMT’S THINK IS NOT THE SAME!!!! DO NOT DIE A STUPID, AVOIDABLE DEATH BECAUSE OF MISUNDERSTANDING THIS

Thank you.
My mother had a DNR as she was getting near the end of her road but I felt there should have been more than a blanket DNR in the few yrs. before her passing.

I did not know how to convey my concerns about how everything was lumped together for DNR.
She eventually got into hospice and passed quickly so it was not an issue.
But when she signed the paperwork, I felt like she was looking ahead to the future, not tomorrow.

Thanks, doc

I would counter sjtill argument... everyone needs to decide ahead of time when the line is crossed. Thus, you, the patient decides when and if you are to be resuscitated.

I believe that "death has become optional" in the US. Too much, too often we are keeping people alive for incredibly selfish reasons. Most do not understand that the fragility of life is measured in minutes ... no long period of times. Thus, absent spontaneous cardiac output ... cerebral injury begins to happen quickly. Thus, the person who arrested is not usually the person who survives the arrest.

If you make the decision about how you live, you should also decide how you die. Full stop. Take that responsibility & burden from your family.

Don't leave this decision to the medical personel who just happen to be avail. And don't leave it to your family to decide in a time of crisis.

I truly wish everyone could see the brutal efforts that happen with code arrests. In fact, I make it a point of not removing the family from the room. Not as punishment but as a window into reality.

Sad fact.... code arrests in hospital are only about 17% survivable with good neurological outcomes. Overall survivability is only 33%.

Do yourself a favor, discuss it with your family. Today!!

Andrew

Thank you for this thread.

This is something that needs careful consideration.

quote:

Originally posted by El Cid 92:
I would counter sjtill argument... everyone needs to decide ahead of time when the line is crossed. Thus, you, the patient decides when and if you are to be resuscitated...

Totally agree with this. Put it in writing, ahead of time, what you want and NOT want to be done.

quote:

code arrests in hospital are only about 17% survivable with good neurological outcomes. Overall survivability is only 33%.

My records are even worse. When I worked in the ER many years ago for a span of 7 years, we ran codes all over the hospital, in addition to the ones in the ER. Not a single shift went without a code. How many were saved? Two.

My mother had an event recently. The hospital called me. I'm 100 miles away. Mother is 100. They wanted a clarification on the Advance thing. This was before they might need it. I said Mother wants "revival" equipment, but not "survival" equipment. They understood. Mother is OK now.

You can get into a whole lot more detail of what you do and don’t want depending on circumstances in a Directive to Physicians, which is a standard Estate Planning package document in Texas.

Okay, so.

There are a few things to consider here. After having a few NDE, I found out the hard way that there is a huge difference between having no heart beat and 'flatlining'.

Having no rhythm means that everything still works. There can still be oxygen present at a cellular level. All they would have to do is whip out some paddles and go to town with some CPR. Yes, I am simplifying it quite a bit, but there are a few minutes to go before anything irreversible presents itself. Atrial means there is still a chance. No activity means it is game over.

Clarify the difference between having a simple reset versus unsustainable long term intervention.

Either way, if a loved one is passing away, talk to them even though they would be clinically 'gone'. They can still hear you.

Throughout history there have always been evidence of post-mortem interaction and reflex responses with the recently deceased.

I agree with sjtill, If the sparks come out of my ears like the 4th of July, keep going until I smell like bacon. When the doc says I'm a veggiedude, there are still a few requests on what to try next before finally pulling the plug.

El CID’s post is not counter to mine, it supplements it.
What people should have is a durable power of attorney for health care (DPAHC) that
1. Delegates one individual as the person to make decisions on medical care if the patients unable to
2. Sets out options in different scenarios that describe what patient would like to have done regarding end of life decisions

A DPAHC is much more than a DNR/NO DNR order.

My objection is to forcing people to decide whether or not to resuscitate without the specifics and subtleties explained in detail to the patient that should be done in a more relaxed setting, ideally with a physician who knows the patient well.

I started this thread because I thought the direction of Konata88’s post about DNR orders was not reflecting the depth of discussion needed.

I dealt with these issues I would suspect far more often than anyone else in this forum—thousands of times, over a career of over 40 years in medical practice.

Hell yes, if I go into V-Fib or ventricular tachycardia, I want them to break out a AED and hit me with electricity to hopefully bring back to sinus rhythm. Doing this in time gives me an over 90% chance of recovering from cardiac arrest. And yes, sjtill is right, a DNR order prevents this life saving action. From the American Health Care Academy website-

quote:

Do-Not-Resuscitate (DNR) Orders:
If the victim has a Do-Not-Resuscitate (DNR) order, it is legally and ethically mandatory to respect their wishes. The AED application in this type of case contradicts the documented preferences of an individual regarding end-of-life care.

A beautiful woman I know died because she had a DNR. She developed an infection in the gut, heart stopped while in the hospital, and because of the DNR they could not resuscitate her. When she was young she was in the Olympics as a gymnast, and now she is gone.

quote:

Your idea of what DNR means and what physicians and nurses think it means are very different.

Thank you for posting this.

quote:

Thank you for posting this.

Thanks, Matt. Means a lot to me--an issue that spans your profession and mine.

Some people may be confusing a DNR with a Medical Directive of when to cease treating because of unrecoverable injury or illness.

e.g. In case of severe brain injury with no hope of meaningful recovery we may direct not to be kept alive by artificial means.

If we have a terminal disease, we may direct not to be resuscitated if it means just prolonging a painful existence a few more days.

Two different documents for two very different scenarios.

In my medical directive, I specified that I want to be kept alive for 10 days, so that my family can travel to say their goodbyes, and in the event that I could "snap out of it".

Too many abbreviations in medicine. I think the point is that the individual's desires need to be spelled out.
DNR= Do Not Resuscitate vs Do Not Rescue.