Withholding Resuscitation

PotatoMedic

PotatoMedic

Has no idea what I'm doing.
Messages
2,749
Reaction score
1,590
Points
113
Earlier I posted a link to a publication done by paramedics regarding withholding resuscitation at pt's, family, or caregivers request. And that got me thinking. How many people have it in their protocols to withhold resuscitation if asked. In my case I can withhold resuscitation if the pt has a terminal illness and they, family, caregiver, or other credible source states they do not want to be resuscitated. (Along with the obvious death list).

Anyone else have something similar? Anyone have any opposition to a protocol like this?
 
We have to have a valid DNR or obvious signs of death. If the DNR cannot be produced, or is invalid, then we have to work them. We cannot accept a living will or a verbal request by family. However, we can call med control in those situations and talk to a doc if there are extenuating circumstances, and we believe withholding resuscitation would be the best thing to do. Then it is up to the doc whether or not we have to work them.
 
Epi-do said:
We have to have a valid DNR or obvious signs of death. If the DNR cannot be produced, or is invalid, then we have to work them. We cannot accept a living will or a verbal request by family. However, we can call med control in those situations and talk to a doc if there are extenuating circumstances, and we believe withholding resuscitation would be the best thing to do. Then it is up to the doc whether or not we have to work them.
Click to expand...

Same here.
 
The better question is who DOESN'T have the ability to withold if requested? Let alone at the providers discretion?
 
We do not need a DNR as long as it seems like a reasonable request. It there is a DNR a family member can override it .
 
Medic Tim said:
We do not need a DNR as long as it seems like a reasonable request. It there is a DNR a family member can override it .
Click to expand...

So what is the point of a DNR if it can be overridden ?
 
Epi-do said:
We have to have a valid DNR or obvious signs of death. If the DNR cannot be produced, or is invalid, then we have to work them. We cannot accept a living will or a verbal request by family. However, we can call med control in those situations and talk to a doc if there are extenuating circumstances, and we believe withholding resuscitation would be the best thing to do. Then it is up to the doc whether or not we have to work them.
Click to expand...

This. Although we are allowed to work a BLS code in those extenuating circumstances instead of starting full ACLS right away
 
Sandog said:
So what is the point of a DNR if it can be overridden ?
Click to expand...

Good question... and one that the lawmakers will have to iron out. Literally here and in TX, if a family member ripped up the DNR after he yanked it from our hands we have to work the code until MCEP tells us we can DC
 
Sandog said:
So what is the point of a DNR if it can be overridden ?
Click to expand...

Other than letting your family and doctor know what you want it isn't worth the paper its written on. IT makes for some interesting situations sometimes as more and more family arrives on scene. A manager told me the dead have no rights here.........doesn't make sense to me either.
 
Here's an aside to this. And this is more rhetorical because the implications...

would you, have you, did you want to...fudge the process a little? I'm not saying I have, or would. I tend to be fairly straight laced, but each have our own ethics, and we've all seen those patients where your hands are tied: you must resuscitate and you just keep thinking how horrible this must be, etc.

I know it gets talked about, no one admits to it (for obvious reasons), but sometimes one wishes it was easier to spare the indignity of our patients...
 
I hate this thread. No sooner do I post in it and I get a 15 yo arrest who was on hospice but no DNR...and no one spoke English except for me, my partner and the fire department.

Fail.
 
I have heard there was a doctor that used to push saline flushes instead of arrest drugs on the B.S. codes and then would call it after a few rounds.

There is a lot that happens in hospitals that really isn't talked admitted. Kind of like physicians (who are now patients) with terminal illnesses that go into respiratory arrest shortly after a visit from a close colleague....
 
ChaseZ33 said:
I have heard there was a doctor that used to push saline flushes instead of arrest drugs on the B.S. codes and then would call it after a few rounds.
Click to expand...

For all the good they do, he could have just used the code drugs. :)

I do not use and do not advocate "show codes." I think it puts providers in exceptional legal risk.
 
ChaseZ33 said:
I have heard there was a doctor that used to push saline flushes instead of arrest drugs on the B.S. codes and then would call it after a few rounds.
Click to expand...

With the medication tracking systems and the accountability, no RN is going to put his or her license on the line since their name is on the code cart sheet and whatever is pulled from the medication system.

ChaseZ33 said:
There is a lot that happens in hospitals that really isn't talked admitted. Kind of like physicians (who are now patients) with terminal illnesses that go into respiratory arrest shortly after a visit from a close colleague....
Click to expand...

If a doctor thinks that is a better way than just writing a very liberal comfort care order, it is his or her license to risk.

But, where were these doctors when Jack or some of the others were proposing a better way to die for those with terminal illnesses.

You will see what is called "terminal weans" in the ICU if you get to work in one as an RN.
 
Veneficus said:
For all the good they do, he could have just used the code drugs. :)

I do not use and do not advocate "show codes." I think it puts providers in exceptional legal risk.
Click to expand...

What would you recommend, then?

If a medic is called for a patient that is freshly dead, with no traditional signs of obvious death, what are they supposed to do?

We typically start working it BLS, and immediately call for cease resuscitation orders.
 
JakeEMTP said:
With the medication tracking systems and the accountability, no RN is going to put his or her license on the line since their name is on the code cart sheet and whatever is pulled from the medication system.

If a doctor thinks that is a better way than just writing a very liberal comfort care order, it is his or her license to risk.

But, where were these doctors when Jack or some of the others were proposing a better way to die for those with terminal illnesses.

You will see what is called "terminal weans" in the ICU if you get to work in one as an RN.
Click to expand...

Those stories are not recent, I believe the doctor retired years ago. I agree it would be too risky with current practices, however there are still a lot of small hospitals who still use med carts and no electronic systems
 
Last edited by a moderator:
ChaseZ33 said:
I have heard there was a doctor that used to push saline flushes instead of arrest drugs on the B.S. codes and then would call it after a few rounds.

There is a lot that happens in hospitals that really isn't talked admitted. Kind of like physicians (who are now patients) with terminal illnesses that go into respiratory arrest shortly after a visit from a close colleague....
Click to expand...

Probably has just as good of a chance at ROSC pushing saline as he would with epi or any other drug
 
Our protocols are simple. We have to physically see the DNR/ (advanced health directive) or have other instruction from a treating physician to withhold resus.

Palliative care is done poorly here. I've transferred dying palliative care patients in their last hours to hospital with the families having no DNR's in place. It put us in an awkward and horrible situation. Physicians have far more power and once in the ED can discuss the wishes of the patient/family and decide to withold resus.
 
You must log in or register to reply here.
Back
Top