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DNR does not mean NO CARE

Sunday, April 6th, 2008

Often times at Medicine ward, I encouter patients family deciding to have a DNR or Do Not Resuscitate order. Once they decide, they have to sign the patients chart for legality purposes. But what is exactly DNR?

A Do Not Resuscitate, or DNR order is a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. Such an order may be instituted on the basis of an advance directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy; in some jurisdictions, such orders can also be instituted on the basis of a physician’s own initiative, usually when resuscitation would not alter the ultimate outcome of a disease, and is designed to prevent unnecessary suffering.

Any person who does not wish to undergo lifesaving treatment in the event of cardiac or respiratory arrest can get a DNR order, although DNR is more commonly done when a person who has an inevitably fatal illness wishes to have a more natural death without painful or invasive medical procedures.

In real life encounter at the ward, a patient was brought to the hospital because of CVA or cerebrovascular accident, the patient had continuous decrease in sensorium and decreased in vital signs despite nursing and medical interventions. So, the patient is a candidate for intubation or we have to place a tube to the mouth to help the patients breath because some clotted blood might affect the respiratory center of the brain. But the family decided to avoid resuscitating the patient. Supposedly, we should intubate the patient and if the patient will go on cardiac arrest, we have to perform CPR and inject epinephrine. 

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Posted by marcopolo at 9:46 pm | permalink | comments[6]