Re: DNR question

August 9, 2007

In a message dated 09-Aug-07 18:11:57 Central Daylight Time,

texasmedic2000@... writes:

I know that EMS is required to honor valid DNRs, and the DNR specifys

that the patient is requestsing that CPR, advanced airway, pacing etc

not be initated or continued.

My question is, when does the DNR become effective? If a patient is in

respiratory distress and hypoxic, should they be intubated if they have

a DNR? OR, does the DNR become effective only when the patients heart

stops, as stated on the DSHS DRN page?

I prefer to try to document (for the patients I've had in the past where

this is appropriate) " comfort measures only " and specify which comfort measures

are considered appropriate after I've had a chance to discuss the situation

with the patient and family.

If the patient has a " Do Not Resusciate " decree in place, and you proceed to

put a tube in their throat and breath for them despite their expressed

wishes, you are liable to have some 'splaining to do some where down the road.

As

a medic, following appropriate protocols for your area in regards to DNRs,

AND following the patient's previously expressed wishes (as evidenced by the

DNR), you probably would not face anything worse than a review panel (at which

time, your sterling documentation of the patient's condition and DNR status

will keep you out of more hot water...) if that much.

That being said, I've ordered or done 'life saving steps' on patients whom I

knew had DNRs in place, but who had a decent quality of life that was being

interrupted by an acute, expected to be limited, situation, and who had a good

chance of recovery to baseline function after the 'life saving steps' were

done.

So it becomes questions of 'why is the patient dyspneic, hypoxic and in

distress?' and what does the patient (if able to communicate) or DPOA/Family

want

done at the time of the incident?

ck

S. Krin, DO FAAFP

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