DNR Question

[medic417]

Even so, can't you call the receiving facility and speak to the ER doc?

You have to have contact to talk to them. My area you can not hit the hospital by radio and cell phones don't work in many areas. It is just me and my partner.

 

[ffemt8978]

You have to have contact to talk to them. My area you can not hit the hospital by radio and cell phones don't work in many areas. It is just me and my partner.

You're not anywhere near me, are you? Around here, smoke signals seem to be the most reliable form of communication.

 

[Pudge40]

In Pennsylvania the BLS protocols states that if they go into respritory arrest we are not allowed to bag them it does not state about if they are in distress though. And the only DNR that we can accept is an out of hospital DNR. If they have a normal DNR we must start CPR and contact medical comand to get the order to stop.

 

[MJD1521]

If a patient has a valid DNR, and they are having inadequate breathing, does the DNR apply to lets say bagging them? How bout not breathing? Does DNR only apply to CPR/Shocking interventions?


I have a difficult partner that thinks she knows everything and was wondering what the correct answer is

Most DNR's in my experience will have a list of treatment options that the patient would not like should they go into cardiac or respiratory arrest. Up until you determine that they are in fact in cardiac or respiratory arrest, treat as you would any other patient.

(This is my understanding of it)

 

[frdude1000]

A DNR (Do Not Resuscitate) order is a form of an advance directive. An advance directive "tells medical responders and doctors what kind of care you would like to have if you become unable to make medical decisions". A DNR specifically states to do not do cpr or try to restart the heart. Also, it also states to not try to restore breathing because that falls under "resuscitate".

 

[Juxel]

I had a difficult DNR case recently. Pt has terminal lung cancer and lives at a nursing home. Staff called pt's wife to inform her of pt's deteriorating condition and wife asked for him to be brought to the hospital. 911 is called.

We arrive to find pt in severe respiratory distress (RR-70ish, O2 sats in the 60s, only response you can get from the pt is eye opening to voice). Staff cannot find his DNR order, but states he has one. We are ~15 minutes from the hospital Code 3.

I bagged him for the trip in. No IV, no airway devices, no meds, just a little assistance moving some air. Enroute to hospital I contacted online med control who pulled his chart up and saw a copy of his valid DNR. Wife arrived at the ED about the same time we did with a son. They were able to say goodbye before the pt died 7 minutes later.

While I was writing my chart I was debating whether or not I should have bagged him. Before I finished writing the chart his wife and son came up to me and thanked me for doing everything I did and giving them the chance to say goodbye one last time. I knew then I did the right thing, at least for this patient.

 

[Katie Elaine]

I'm a bit confused. I'm a new B-tech, and during my class I remember we had quite a debate about DNRs and what they cover and what they don't. Doesn't the DNR have a list of things that you can and cannot do? From what my instructor talked to us about, I gather that the patient says what interventions they want and are acceptable, and where to stop resucitation.

 

[JPINFV]

It's really a location by location issue. Some due have more information in terms of what interventions the patient wants and doesn't want. Others just ban life support measures such as mechanical ventilation, CPR, defibrillation, cardioversion, and the like.

 

[medicp94dao]

DNR = Do Not Resuscitate NOT Do Not Treat QUOTE]

i agree. if the are dead leave them that way. if they have a pulse, and are breathing then you work them. To quote my medical director " a DNR can be revoked at anytime this includes death" a pt family member of at least 18 years of age and is a close family member i.e;parents, children, siblings, and grandchildren can revoke the DNR at any time and it only takes one to do so. Even if you are holding the VALID DNR in your hand and one of them say to save that pt, you have to do as they wish...... if in doubt always consult medical direction...

 

[TransportJockey]

DNR = Do Not Resuscitate NOT Do Not Treat QUOTE]

i agree. if the are dead leave them that way. if they have a pulse, and are breathing then you work them. To quote my medical director " a DNR can be revoked at anytime this includes death" a pt family member of at least 18 years of age and is a close family member i.e;parents, children, siblings, and grandchildren can revoke the DNR at any time and it only takes one to do so. Even if you are holding the VALID DNR in your hand and one of them say to save that pt, you have to do as they wish...... if in doubt always consult medical direction...

Any family member over 18? I've never heard that. In NM only a POA or the pt themselves can revoke the DNR. If a pt's son who is not POA tried to tell me to work the code, I still would be breaking the law by doing it

Also NM has a specific EMS DNR. Cuts down on hassles

 

[EMTinNEPA]

I was under the impression that only the patient's medical power of attorney could override a DNR.

 

[Ridryder911]

I was under the impression that only the patient's medical power of attorney could override a DNR.

Actually, most states describe that the patient or any immediate family member can interupt and cease DNR orders.

R/r 911

 

[reaper]

Yes, in most states immediate family can override a DNR. It is usually for selfish reasons and should not be aloud, but it is valid.

 

[JPINFV]

^
What if the patient said "Save me," just before s/he coded? Resuscitation and life support can always be stopped/withdrawn. Once you decide to terminate a resuscitation/life support, you can't go back.

 

[TransportJockey]

^
What if the patient said "Save me," just before s/he coded? Resuscitation and life support can always be stopped/withdrawn. Once you decide to terminate a resuscitation/life support, you can't go back.

The patient, the one who originally filed the paperwork,has every right to withdraw that document

 

[JPINFV]

^
Yes, and that's my point. What if the patient withdrew the DNR just prior to going into cardiac arrest. EMS gets called, shows up, finds DNR, and family asks EMS to resuscitate the patient. Hence the reason why family should be able to withdraw the DNR as well as the patient.

 

[Moxiy]

If it means anything, I just finished my EMT class and my professor on the last day of class confirmed that BVM is indeed a form of Resuscitation and should not be applied during a DNR.

 

[TransportJockey]

^
Yes, and that's my point. What if the patient withdrew the DNR just prior to going into cardiac arrest. EMS gets called, shows up, finds DNR, and family asks EMS to resuscitate the patient. Hence the reason why family should be able to withdraw the DNR as well as the patient.

If the pt has been of sound mind until the point he dies, why should the family have a say in it? If the pt doesn't want to be resuscitated, then do not do it. It seems like the family will always ask you to invalidate the DNR, at least around here it does.

 

[Ridryder911]

If the pt has been of sound mind until the point he dies, why should the family have a say in it? If the pt doesn't want to be resuscitated, then do not do it. It seems like the family will always ask you to invalidate the DNR, at least around here it does.

Because most states will honor the "loved ones request". This is a dangerous area and most services have a legal protocol in case it happens. Ours it to proceed with resuscitation as it is clear within my state that ..."the patient, immediate family members, patients proxy may remove DNR status at anytime"....

I have read of court cases where EMS did not honor immediate family member request and was held responsible. So, again I would consult with your legal department for clarification.

R/r 911

 

[VentMedic]

If it means anything, I just finished my EMT class and my professor on the last day of class confirmed that BVM is indeed a form of Resuscitation and should not be applied during a DNR.

In some states that is not always true. A DNI (Do Not Intubate) order may also need to accompany the DNR. If it is impending respiratory failure from PNA or CHF, we may use Non Invasive Ventilation or even intubate for conditions that are deemed to be reversible.