DNR - NO Artificial Ventilation and the use of a BVM?

[TheLocalMedic]

Regardless, assisting ventilation is a non-invasive procedure that can absolutely be used to treat respiratory distress, even if they have a DNR. Throwing up your hands and saying, "Can't help you! You've got a DNR!" is a big misunderstanding. You should absolutely treat them up until that DNR kicks in: when they quit breathing or lose a pulse.

 

[mycrofft]

There seems to be considerable regional variations in terminology.

Where I was trained (NYS), a DNR does not kick in until the patient loses pulses and/or spontaneous respirations. Up until that point, you treat them just like every other patient, meaning assisting with ventilations and even intubating if indicated, along with pressors, blood, surgery, and other resuscitative measures.

If they don't want ventilation or intubation or pressors, then that requires a different type of advanced directive. A DNR itself does not apply until a respiratory or cardiac arrest has occurred.

A DNR stating you forbid resuscitation which only works once resuscitation has failed means either it's meaningless, or you suck at resuscitation (maybe on purpose).

 

[mycrofft]

Regardless, assisting ventilation is a non-invasive procedure that can absolutely be used to treat respiratory distress, even if they have a DNR. Throwing up your hands and saying, "Can't help you! You've got a DNR!" is a big misunderstanding. You should absolutely treat them up until that DNR kicks in: when they quit breathing or lose a pulse.

"Sir or Ma'am, would you like me to help you breathe?".

PS: anyone saying being BVM'ed isn't intrusive obviously hasn't had it done to them. Especially with that yummy canned oxygen.<_<

 

[Mark Lassman]

That makes sense. Thank you.

 

[JPINFV]

Resuscitation is not limited to patients in pulse-less situations, but any time an acutely life threatening event is present. The patient who was in septic shock and received pressures and fluids to stabilize his blood pressure has been resuscitated. If you are using a BVM on anybody who is not already vent dependent, you are engaged in a resuscitation.

 

[Hunter]

Resuscitation is not limited to patients in pulse-less situations, but any time an acutely life threatening event is present. The patient who was in septic shock and received pressures and fluids to stabilize his blood pressure has been resuscitated. If you are using a BVM on anybody who is not already vent dependent, you are engaged in a resuscitation.

By that logic though would you call a hypoglycemic shock patient who's received D50 a resuscitated patient? Would you withhold the D50?

 

[Akulahawk]

By that logic though would you call a hypoglycemic shock patient who's received D50 a resuscitated patient? Would you withhold the D50?

Being that D50 provides calories to a patient, wouldn't simply feeding a patient be considered resuscitation, using the same logic?

My answer is no, I wouldn't normally withhold D50. It's not among the list of things I'm not allowed to do when presented a DNR. It may, however, not be something I'm allowed to provide if the patient's POLST forbids it.

 

[Hunter]

being that d50 provides calories to a patient, wouldn't simply feeding a patient be considered resuscitation, using the same logic?

My answer is no, i wouldn't normally withhold d50. It's not among the list of things i'm not allowed to do when presented a dnr. It may, however, not be something i'm allowed to provide if the patient's polst forbids it.

polst?

 

[NomadicMedic]

POLST. Physician's orders for life sustaining treatment. It's become the accepted a la carte "DNR" form in many states.

 

[JPINFV]

By that logic though would you call a hypoglycemic shock patient who's received D50 a resuscitated patient? Would you withhold the D50?

Yes...

...and yes if the DNR specifically mentioned no IV dextrose (or some sort of equivalent wording). I've yet to see anything close to that. In general DNRs are very specific about what is and what is not allowed and when they're in effect.

On the other hand, the concept of "no artificial respiration if the patient doesn't have a pulse, but hey, there's a pulse so we're good" is absurd when presented with a DNR that says "no artificial respiration, period."

 

[JPINFV]

POLST. Physician's orders for life sustaining treatment. It's become the accepted a la carte "DNR" form in many states.

...which is why I consider them to be the same thing. Heck, even before POLSTs became popular, I've seen DNRs from some facilities spell out very specifically what the patient does or does not want, including things like antibiotics and hospitalization.

 

[Rialaigh]

Yes...

...and yes if the DNR specifically mentioned no IV dextrose (or some sort of equivalent wording). I've yet to see anything close to that. In general DNRs are very specific about what is and what is not allowed and when they're in effect.

On the other hand, the concept of "no artificial respiration if the patient doesn't have a pulse, but hey, there's a pulse so we're good" is absurd when presented with a DNR that says "no artificial respiration, period."

I'm glad someone else agrees here. I think the "all or nothing" mentality is one of the worst things left in EMS. I don't give every single trouble breathing patient a steroid...it's in the protocols but I choose to withhold it for various reasons...I use critical thinking and make a decision based on a;l the signs and symptoms other information presented to me. I do the same when presented with a DNR