DNR discussion
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jeepmedic
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She was unresponsive so an Adult Child can act as POA for medical treatment in Virginia as long as the pt's. spouse is not present.
Ok, I'll take your word for it, I knew some did...thanks
Wow, I didn't know that, I wonder if that's unique to virginia or not.
Did the son sign the dnr, if not, his is probably not authorized to make this decision...I'm not a lawyer and Va could have a screwy law but nationally this is usually the case...if you want to make a decision then you have to have signed the dnr.
jeepmedic
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I don't know but the Virginia law has a list of people in order who can make Medical choices. It can get confusing(sp). If a family member defaces the DDNR then it is no longer valid. There are alot of different ways around a DDNR if the family wants to get around it. The more I research the law the more I don't Like it.
For the record I would have Intubated her to secure her Airway. This is to prevent aspiration. There has been comments made that her airway was not compromised well that don't flush with me. How many times are 20 something year olds intubated because they have a head injury? (Everyone that has a provider that can intubate will). This is so that they do not compromise their airway. Not because their airway is already compromised.
It has also been said that it didn't matter what was done it would not have changed the outcome of the pt.. Well I again think this is bull. You will never know. If the brain had have been given enough O2 then maybe. Who knows?
The bottom line is a Jr. ALS provider wanted to treat a pt. and was stopped by a Sr. Medic. And this was because the pt. had a DDNR. Which is not a Do Not Treat.
(Now my ears are red)
For the record I would have Intubated her to secure her Airway. This is to prevent aspiration. There has been comments made that her airway was not compromised well that don't flush with me. How many times are 20 something year olds intubated because they have a head injury? (Everyone that has a provider that can intubate will). This is so that they do not compromise their airway. Not because their airway is already compromised.
It has also been said that it didn't matter what was done it would not have changed the outcome of the pt.. Well I again think this is bull. You will never know. If the brain had have been given enough O2 then maybe. Who knows?
The bottom line is a Jr. ALS provider wanted to treat a pt. and was stopped by a Sr. Medic. And this was because the pt. had a DDNR. Which is not a Do Not Treat.
(Now my ears are red)
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FUN! This situation is tricky, because here in SC a DNR means no cardiac or respiratory skill (defib, ETT, CPR, or diagnostic monitoring). I would ventilate the patient with the BVM, as I am aonly assisting them, if the patient goes apneic it chages the parameters. I would be hesitant on calling the helicopter to transport as the trauma services here will not treat DNR patients like they would a non DNR person because of the way the laws were written. I would take her to the level 1 center though. I would also give her IV fluids, and non cardiac related meds. DNR means no NTG,ASA, morphine for chest pain, Epi, Atropine, Lidocaine, Adenocard, Mag Sulfate, Ca, and the like. I can give NTG and morphine for CHF and pulmonary edema. I can also give the other drugs. I would treat this women to the utmost of my ablility while remaining in line with the law.
In SC a DNR can only be revoked by distruction, alteration, mulitation, or an oral statement form the person who has the DNR. Family members don't count even if the are the POA, the exception being if they signed the DNR for their family member in the case where the patient in unable to comprehend their condition.
In SC a DNR can only be revoked by distruction, alteration, mulitation, or an oral statement form the person who has the DNR. Family members don't count even if the are the POA, the exception being if they signed the DNR for their family member in the case where the patient in unable to comprehend their condition.
jeepmedic
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What happens to a pt that goes in for hip replacement Surg.? They get intubated. Even if they have a DDNR.
trauma1534
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For the record, I work in the surgery at a level one trauma center, and they do surg everyday on DNR patients... and guess what? Those patients get intubated during surgery!
prizonmedik
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IMHO The DNR applies only to the terminal condition, not other trauma. Anyway, I'd rather explain why I tried to save a person, than why I let them die. And why was **** there anyway?
trauma1534
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He was called there per his father. I was set to do everything possable for this patient, until "Mightymedic" showed up. That's a whole other story that you well know without me getting into it.
Dnr
I think the key thing to remember is that DNR does not mean do not treat. I think that is a big misconception among nursing home staff and nurses in NY state. Of the nursing homes I respond to, that is one of the most frequent states, they have a dnr, never mind the fact that the patients pulse ox is in the 70's, or they are unresponsive. In NY, you still have to follow all protocols that apply/
I think the key thing to remember is that DNR does not mean do not treat. I think that is a big misconception among nursing home staff and nurses in NY state. Of the nursing homes I respond to, that is one of the most frequent states, they have a dnr, never mind the fact that the patients pulse ox is in the 70's, or they are unresponsive. In NY, you still have to follow all protocols that apply/
yowzer
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Washington has a standard form called the POLST (Physician's Orders for Life-Sustaining Treatment) that spells out just what treatment someone desires -- comfort measures, 'limited' interventions, IVs, antibiotics, tube feeding, the full meal deal of working a code, etc. It's really nice to have when it's filled out correctly. http://www.wsma.org/patients/polst.html has an online copy of the form. I think some other states (Ohio?) have adopted it too, or something similar.