Guest guest Posted August 9, 2007 Report Share Posted August 9, 2007 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? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2007 Report Share Posted August 9, 2007 I think a DNR is valid prior to arrest. I would assume, and do regularly, that the DNR is in effect as soon as it is implemented or expressed unless there is evidence it is not deisred anymore (patient or representative has rescinded it.) If a patient or pt rep is able to be communicated with then it is reasonable to discuss with them whether under these particular circumstances they would want DNR respected. I had a nurse get on to me the other day because I discussed a DNR and redacted it temporarily after my discussion with the patient. I felt he was lucid and competent and any time I feel that is the case then there is no point to the DNR at that point, I just ASK the patient what they want for that particular time period (in this case hospital admission.) If however they are not competent or have altered mental status, I think you gotta follow the DNR. Of course the remaining family is the one who you deal with if there is any controversy so its always best to get them on the same page. My 2 cents.. Kirk D. Mahon, MD, ABEM 6106 Keller Springs Rd Dallas, TX 75248 _________________________________________________________________ Now you can see trouble…before he arrives http://newlivehotmail.com/?ocid=TXT_TAGHM_migration_HM_viral_protection_0507 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 9, 2007 Report Share Posted August 9, 2007 I think a DNR is valid prior to arrest. I would assume, and do regularly, that the DNR is in effect as soon as it is implemented or expressed unless there is evidence it is not deisred anymore (patient or representative has rescinded it.) If a patient or pt rep is able to be communicated with then it is reasonable to discuss with them whether under these particular circumstances they would want DNR respected. I had a nurse get on to me the other day because I discussed a DNR and redacted it temporarily after my discussion with the patient. I felt he was lucid and competent and any time I feel that is the case then there is no point to the DNR at that point, I just ASK the patient what they want for that particular time period (in this case hospital admission.) If however they are not competent or have altered mental status, I think you gotta follow the DNR. Of course the remaining family is the one who you deal with if there is any controversy so its always best to get them on the same page. My 2 cents.. Kirk D. Mahon, MD, ABEM 6106 Keller Springs Rd Dallas, TX 75248 _________________________________________________________________ Puzzles, trivia teasers, word scrambles and more. Play for your chance to win! http://club.live.com/home.aspx?icid=CLUB_hotmailtextlink Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2007 Report Share Posted August 10, 2007 The DNR becomes effective the moment it is completed. State law requires that EMS personnel honor the DNR the moment it is presented to them and they determine that it is legitimate. A DNR written on the Texas Out-of-Hospital DNR Order Form is the physician's order to EMS personnel. It has the same validity as an order given by an EMS Medical Director or base station physician. That is, we don't get to decide if we want to follow the order , of if we want to follow it immediately or later. One of the treatments that the patient specifies he/she does not want when he/she signs the DNR (and this is specified on the DNR form) is intubation. None of the BLS procedures, such as administering oxygen or assisting ventilations with a BVM, are prohibited. I have counseled many persons about whether or not they should have a DNR, and what will happen when EMS arrives if they do and do not have one. My experience as an EMS administrator has been that people are grateful when we speak to them in a direct manner and explain the facts. When they are not yet to their terminal event they want medical care that will enable them to live as fully as possible. When they get to their terminal event, they do not want their life to be artifically prolonged. My expeirence as a field paramedic has been that people do not turn down the offer of oxygen and other comfort care that eases their suffering. And, they often desire some ALS care, such as an IV and pain control but they do refuse intubation. When presented with a DNR for a patient who is not yet in cardiac or respiratory arrest, we need to assess the patient and honestly tell them what we find, if we think we can help them, and what their options are. Unless they specifically give us permission to intubate, or anything else the DNR specifically says we cannot do, we must withhold those treatments specified on the DNR Order. > > 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? > Quote Link to comment Share on other sites More sharing options...
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