Unsuccessful Resuscitation

[RocketMedic]

Agh, I want to do this so badly. I spoke to my medical director about the likelihood of him granting orders for it if called though and was told it would be no every time :/

It requires two Acadian monitors here (due to potential equipment damage) but there's really no harm to it...not like they're getting deader.

 

[teedubbyaw]

I've not attempted resuscitation without the DNR several times. Patient's family states they have one but not with them or not sure where it is, quick call to the doc and pronounce right there.

What happens when you get denied? Delayed care so you could call medical control?

I don't trust people enough to do that.

 

[NomadicMedic]

His rationale?

"I'm the doc and I said so".

If it was who I think it was, I'm SURE that was his rationale

 

[triemal04]

What happens when you get denied? Delayed care so you could call medical control?

I don't trust people enough to do that.

Here's a better question for that situation: what happens when the family who doesn't want you to work the call due to the DNR (present or not) starts screaming at you to stop when you start CPR after getting denied?

 

[teedubbyaw]

Here's a better question for that situation: what happens when the family who doesn't want you to work the call due to the DNR (present or not) starts screaming at you to stop when you start CPR after getting denied?

His step kids are entitled to a big pay out when he dies. He really doesn't have a DNR.

 

[triemal04]

His step kids are entitled to a big pay out when he dies. He really doesn't have a DNR.

I'm being very serious. If you, or anyone, works for a department that will put them in that situation, you should have an idea of what you're going to do.

I can't count the number of times that I've been dispatched for a CPR because the family briefly panicked when the person died (or didn't understand the DNR if it was there), OR because dispatch didn't understand that they didn't want a medical response, just the police.

If you get put into that situation, where nobody actually wants CPR done but you don't have the magic piece of paper...what will you do when the family that is present goes nuts as you start compressions?

 

[Carlos Danger]

Here's a better question for that situation: what happens when the family who doesn't want you to work the call due to the DNR (present or not) starts screaming at you to stop when you start CPR after getting denied?

That's a good question.

I once worked in a very high-acuity SICU where people died all the time (I guess we weren't a very good ICU?), and it was very common for them to not have a valid DNR in effect.

In those scenarios, we simply did what the family said the patient would want, and of course documented that.

The whole "a signed DNR must be physically present no matter what" is pretty dumb.

 

[teedubbyaw]

I'm being very serious.

I wasn't.

Though, my point is that it's not always cut and dry like that, unfortunately. Doing what is best for the patient and family will have the greatest outcome, but there is always that one family that is batshit crazy.

 

[STXmedic]

What happens when you get denied? Delayed care so you could call medical control?

I don't trust people enough to do that.

We'll begin chest compressions until we get the official okay, but nothing more. It takes all of 20 seconds to get them on the phone, and less than a minute to get the okay. I know our docs pretty well and know what they're comfortable with. They also know my crew pretty well and trust our judgement. Perks to working with our docs on a regular basis I suppose.

 

[Chimpie]

I know our docs pretty well and know what they're comfortable with. They also know my crew pretty well and trust our judgement. Perks to working with our docs on a regular basis I suppose.

This is another reason why it pays to play nice with everyone. You never know when that partnership/relationship is going to be needed.

 

[triemal04]

That's a good question.

I once worked in a very high-acuity SICU where people died all the time (I guess we weren't a very good ICU?), and it was very common for them to not have a valid DNR in effect.

In those scenarios, we simply did what the family said the patient would want, and of course documented that.

The whole "a signed DNR must be physically present no matter what" is pretty dumb.

It is extremely dumb...but, in probably the majority of services that's still a requirement. As is calling in for permission to stop a resuscitation/not work one. Which can lead to some interesting complications if you get the wrong doc on the phone...

 

[luke_31]

It is extremely dumb...but, in probably the majority of services that's still a requirement. As is calling in for permission to stop a resuscitation/not work one. Which can lead to some interesting complications if you get the wrong doc on the phone...

Been there done that. Person down for unknown length of time, some lividity and the doc still had us work it