What you say is true Rid, but not all of the DNRs or DNIs are going to die here and now. If they are fluid overloaded, have a fever, get PNA or they are in pain, they deserve to be treated if death is not in the immediate future.
Some 20 - 35 y/os make their DNR status known on the first day they are dx'd with CA or HIV. Does that mean we stop treatment on them? No, it just means we will not do anything heroic once their heart stops. We also have children that have made their DNR status known at a very young age but we will continue to treat until they are placed on comfort care. The same with the adults. We will continue to treat the fluid overload induced CHF or fever until the comfort care orders are in place. No one deserves to be thought of as a "Do nothing" DNR pt.
I know you have seen the suffering that a DNR order has also brought patients. That is not the intent of that order but too often the continued needs of these patients are ignored once the order is signed. Physicians will continue to be reluctant to push for DNRs due to the "Do Not Treat" mentality at both the hospital and EMS level. The physicians will continue to see that their patients are treated and the same standard of care is provided until the end is near. Once a patient is close to dying the next level of Comfort Care should be instituted to ensure the patient dies as comfortably as possible and not gasping for breath while in pain at the end of the hall. There are few things sadder than to hear "just a DNR" from an EMS crew at the ED triage area. It seems like to some, once the DNR order exists the patient ceases to exist. Our elderly and terminally ill deserve better.
I definitely hate to see an elderly patient on a ventilator. Unfortunately, it is often inevitable in some nursing home patients without a DNR status due to that fever that is sepsis but the transfer took longer to arrange than planned. 911 could have been called for a quicker response but then the nurses at the nursing home, trying to do the right thing, will get the Paramedics ticked off because it is just a "fever". I'm not saying that all patients with a fever will get a ventilator but many do.
Some 20 - 35 y/os make their DNR status known on the first day they are dx'd with CA or HIV. Does that mean we stop treatment on them? No, it just means we will not do anything heroic once their heart stops. We also have children that have made their DNR status known at a very young age but we will continue to treat until they are placed on comfort care. The same with the adults. We will continue to treat the fluid overload induced CHF or fever until the comfort care orders are in place. No one deserves to be thought of as a "Do nothing" DNR pt.
I know you have seen the suffering that a DNR order has also brought patients. That is not the intent of that order but too often the continued needs of these patients are ignored once the order is signed. Physicians will continue to be reluctant to push for DNRs due to the "Do Not Treat" mentality at both the hospital and EMS level. The physicians will continue to see that their patients are treated and the same standard of care is provided until the end is near. Once a patient is close to dying the next level of Comfort Care should be instituted to ensure the patient dies as comfortably as possible and not gasping for breath while in pain at the end of the hall. There are few things sadder than to hear "just a DNR" from an EMS crew at the ED triage area. It seems like to some, once the DNR order exists the patient ceases to exist. Our elderly and terminally ill deserve better.
I definitely hate to see an elderly patient on a ventilator. Unfortunately, it is often inevitable in some nursing home patients without a DNR status due to that fever that is sepsis but the transfer took longer to arrange than planned. 911 could have been called for a quicker response but then the nurses at the nursing home, trying to do the right thing, will get the Paramedics ticked off because it is just a "fever". I'm not saying that all patients with a fever will get a ventilator but many do.
Last edited by a moderator:
