97 year old, STEMI

[Handsome Robb]

My oldest STEMI was 91yo, DNR/DNI, in a nursing home recovering from a hip fx. Received a stent in the LAD.

What kind of co-morbidities though. I've seen plenty of very independent, healthy 91 year olds.

 

[Rialaigh]

At what age would it be an emergency? If the pt is DNR/DNI without special instrutions on POLST he would go to the PCI in our area.

Our take on DNR/DNI is agressive treatment up to the poiint of cardiac arrest. Special instrutions would be the supporative care route.

I am in my 50's I would like DNR. But I would also like to be taken to the PCI for my MI.

As you get older and you have more comorbidities it becomes less of an emergency. With higher reward comes a higher willingness to expend resources and take risks.


Quite frankly this "all or nothing" attitude of EMS regarding DNR's and patients is so far behind the times it is crazy.

 

[NomadicMedic]

I think you're missing the point here... There was no "all or nothing". I wanted to speak to the POA, not withhold treatment.

Here's the situation:

The patient was in the dementia unit. She was not oriented in any sphere.

She had a history of serious GI bleeds, and was transported by me, two weeks prior.

The family/POA was adamantly against any imaging studies or invasive procedures.

The family/POA was adamantly against transport to any facility other than the community hospital, albeit a level III, that had no PCI capabilities.

Did I think the PT was going to die in my care? No. Did I think taking the time to contact the family and tell the what was going on was worth the time? Yes. I would have loved to prevent additional IFT, and let the family know why I wanted to go to a different hospital.

At any rate, she went to the community hospital. I'm sure she was medically managed and is either still an inpatient or has been discharged back to the dementia unit. I haven't followed up.