do not rescusitate .............

hi - this thread is not about the " normal " DNR orders - that patients somentimes enact .

this is a look into the`dilemas of first response // rescue in situations where recources // personel are limited - and expernal support is going to take time

yup - its a bit morbid - so if it makes you uncomfortable - click " back "

so at what point do you take the hard descision not to even attempt CPR or other intervention ???

its a topic that comes up semi regularly - and yup - it does make people squirm

but hey - a lot of things in life are unpalatable .

just for clarity - i am " mainly " talking about response to a casualty who has arrested [ no breathing , no pulse ]

in a situation where there is no AED , adrenaline , ambo-bag , oxygen - anything

your " usefull kit " = 2 asprin and a face sheild

and response time of ANY useful nature = 1 hour or more [ if you are lucky ]

of course - faced with such odds - the answer is slightly easier

but at what point do you draw the line ???????????????????

i am basing this hypothetical on the maxim that defib needs to be administered within 20 min to have any chance [ 10min = prefered ]

ATS has a world wide membership - with varied experience

whats the collective opinion ?

a reply to: ignorant_ape

I worked as a paramedic for quite a long while.

The hardest thing - even beyond baby or child 'calls' was when we responded to a DNR.

Of course, we didn't have all the 'back' information, but, it was heartbreaking to watch someone pass away right there under our hands, when we could have 'brought them back'.

In my belief system - you do all you can to 'come back'.

I remember a story of a FireFighter who was injured while on duty. He was on life support for 9 years. He 'woke up' one day, they called his family in, he was able to tell them all how much he LOVED THEM and CHERISHED THEM - only to pass away 2 days later.

Hang in there. Trust God.

Don't go DNR.

a reply to: ignorant_ape

I think its just one of those things that the individual administering the resuscitation knows and feels in their hearts. They will play out the feeling until it is no longer there. Those who do not, live with the 'what if'.

Yea you're on a roll............................................

If I were to sign one of those papers, I would probably choke at the Hospital caffeteria on some food while bringing the wife in for a test, and they would call the ambulance crew and watch me die saying gee, he signed the paper.

You pay for your food when you get it there, I hate wasting food I have already bought. I want to be able to finish my meal.

So whats the actual questio here?

You have DNR in your thread title, you have a hypothetical in your thread, but you dont actually ask the question of whatever youre trying to get an poll on.

Whats the question.

originally posted by: Disenchanted1
Yea you're on a roll............................................

What do you mean?
You are telling people to stfu and stop, yet you have contributed nothing.
Unless you count Judas Priest lyrics.

The question is "where do you draw the line"?

It's heartbreaking, silo13's testimony. I personally don't understand why anyone would request for DNR, but it sounds like they're already dead inside at that point, so I guess physically they're not that far off. The problem I have is it's kinda like asking someone else to kill you. If somone doesn't want to live, a DNR is just a way to wait for an incident to force someone else to let you perish. If someone else saves you, it is a gift because they see a value in life that apparently the patient does not. Otherwise a DNR seems like a get-rich-quick or die trying scheme to sue someone because they didn't know about a piece of paper (or disregarded it for whatever conviction was in their heart to revive the person). I think what DNR people need is to have hope, not a way out. A verbose way of saying as silo did, "Hang in there. Trust God."

a reply to: silo13

I don’t know why an EMT or a paramedic would feel that a DNR is horrible. I understand that whomever contacted EMS probably didn't realize that the patient had a DNR. Doesn’t the ambulance service that you work for have EMS have a hospice or DNR protocol for providing comfort measures in this situation? O2, pain meds, anxiety meds for patient’s with air hunger due to end stage respiratory compromise?

I can’t think of anything worse than being a patient with a clear advanced directive (DNR) that clearly states your wishes and having an EMS crew or the hospital completely ignore them. I have seen out of hospital DNRs ignored and also in-hospital advanced directives/DNRs ignored in favor of following the wishes of one lone family member who wants the hospital staff to “do everything that they can”.

Common scenario: The patient knows they are terminal -proactively takes legal measures to die exactly how they want to die and when the patient is at his/her most vulnerable (unconscious - minutes from death) the physician asks the family what they want to do instead of following the Patient’s wishes - clearly documented in the advanced directive.

I can’t tell you how many times I have seen that. It is criminal. The patient often doesn’t survive but their death is prolonged by days/weeks/months on a vent until the family “accepts” that this is the end.

Patient with end stage COPD or CHF knows the end is near and clearly documents his/her desire is to die at home. The patient comes so close to death (within minutes of dying) when someone (a random family member or neighbor) realizes patient is dying and calls EMS. DNR is ignored, CPR is administered (breaking a few ribs in the process possibly collapsing a lung), pt is intubated and mechanically ventilated, possibly gets a chest tube inserted at the hospital to treat the pneumothorax, after a week or two in the hospital patient is shipped to a long term care hospital still intubated. Patient survives but is never ok to go back home. Patient dies months later in nursing home setting from complications of long term ventilation (typically aspiration pneumonia). Talk about going out the hard way! Prolonging death can result in a long drawn out painful dying process.


Dying is a process and a natural part of the life cycle just like being born is a process. When people are fighting a terminal illness ir end stage disease they sometimes get to the point to where they accept that this is the end and they take solace in being able to specify how they want to die. Many people want to die at home. They want to be comfortable and die in their own beds. Hospice is an ideal resource for terminally ill patients; however, hospice isn’t discussed early enough or often enough to help many patients.

Ignoring a patient's written advanced directive in favor of a family members wishes isn’t ok; however, it is what doctors do because they are more worried about the living family memebr suing them than being sued by the person who is close to dying.

a reply to: ignorant_ape

Well, I would say with a healthy person, a DNR order is almost never necessary...

First response persons usually will attempt to resuscitate most people in that situation for as long as needed

DNR orders usually only apply to seniors... or people that have a standing order

Basically... "IF i am a vegetable, pull the plug"

originally posted by: c2oden

originally posted by: Disenchanted1
Yea you're on a roll............................................

What do you mean?
You are telling people to stfu and stop, yet you have contributed nothing.
Unless you count Judas Priest lyrics.

Yep! Basically how you float through some stale Morris Day ongoing theme. YEP!

I consider a DNR for those poor unfortunates stuck being forced to "stay alive" day after day, comatose, unable to breathe on their own, think or communicate. Their bodies deteriorate, etc. But, they always talk about "brain activity" or no "brain activity" as to whether to pull the plug or not.

I was there when they pulled the plug" on my uncle. Still don't know if it was the right thing to do-he was a very strong Christian-had NO DNR-so his family decided-not me.

Nope. I never would have done it. I never give up hope. Our current "physicians" have not impressed me enough with their knowledge of actual "life" to make those decisions. Nope.

originally posted by: Buvvy
The patient often doesn’t survive but their death is prolonged by days/weeks/months on a vent until the family “accepts” that this is the end.

Until the family accepts this, they have hope. Is hope worth nothing?

originally posted by: Buvvy
Talk about going out the hard way! Prolonging death can result in a long drawn out painful dying process.

When people are fighting a terminal illness ir end stage disease they sometimes get to the point to where they accept that this is the end and they take solace in being able to specify how they want to die. Many people want to die at home. They want to be comfortable and die in their own beds.

Why must death be quick/easy/convenient? Also, as medical science practices preservation (and comfort), they get better at it for the next one of us. Should we ask them to give up their hope as professionals as well?

originally posted by: Buvvy
Ignoring a patient's written advanced directive in favor of a family members wishes isn’t ok; however, it is what doctors do because they are more worried about the living family memebr suing them than being sued by the person who is close to dying.

The DNR has caused this dilemna. Without it, there would be no question but to always preserve life.

a reply to: saint4God

The DNR order has a purpose...

It wasn't always a part of the medical establishment

a reply to: ignorant_ape

I am trying to understand the scenario you are describing.

So you said you aren’t talking about the traditional DNR. Can you offer up a scenario?

Here is a scenario where an EMT or Paramedic might be in an ethical situation - the dilemma is do you attempt resuscitation or call death on scene.

Young person in a motorcycle accident at a remote location (no ambulance or air evac available > 1 hour from nearest hospital). The injured rider had no helmet on resulting in a frontal lobe open skull fx with brain matter visible on scene. Patient is asystole on scene. Do you attempt CPR?

I don't quite get what the OP is getting at here, but my family has always been & still is pretty straightforward about DNR -- if you're an adult and you decide DNR is the way to go, people need to respect it. When it's our time to kick it, it's our time to kick it. Having some seemingly miraculous, intervention-free comeback would indicate otherwise, and if THAT happens, it's obviously not your time just yet. I'm good with leaving it to chance/"the universe"/whatever. Some folks would call pulling people back from death instead of letting them go "f#ing with fate".

a reply to: saint4God

The Hippocratic Oath says: do no harm. The original version: “Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.”

Just because you can do something (prolong life) doesn’t mean that it is the correct thing to do. It also doesn't mean that it is in the patient’s best interest to do so. Technically a human can be kept alive for an indefinite amount of time sedated on a mechanical vent, iv hydration, peg tube feedings (or TPN).

Just because you can technically keep a person alive doesn't always mean it is the correct course of action. There are also consequences of doing this: muscle atrophy and contractures (hands and feet turning into claws) bedsores (down to visible bone), tracheal stenosis and recurrent infections to lungs (associated with prolonged ventilation), recurrent urinary tract infections (associated,with urinary catheter). Infiltrated veins, phlebitis and cellulitis associated with IVs. Port or central line infections causing sepsis.

So the physician may be doing more harm than good.

For those of you using the religious argument. The patient could have been in heaven if allowed to pass away naturally. Instead the patient’s soul is being artifically trapped in a body here on earth that is just a prison for his/her soul - and for all you know the patient might be in pain.

If a patient has put their wishes in writing in a legal Advanced Directivr then their wishes should be followed.

a reply to: saint4God

In reply to you stating: “Why must death be quick/easy/convenient?”

Your death doesn’t have to be any of those things. However, you don’t have the right to make someone elses death painful or prolonged if their written wishes (advanced directives) state their preferences are otherwise.

You can have all of the hope that you want to have. You can’t impose your hope on others against their written wishes.

Relative “x” of yours who has an Advanced Directive shouldn’t have his/her suffering prolonged while you take your time coming to terms with the fact that they are actively dying.

I don’t know but I think I’ve requested it and need to clarify what I actually meant. I don’t want to be saved to be left in a coma for years suffering in silence not being able to communicate or move. My choice as I believe you are aware and I’ve already spent too much time in hospitals and I don’t feel I was treated with respect and dignity from staff or family.

For one they think you can’t hear as they do that group nod thing of let’s go into the halfway and talk about her. I could hear the mumbling , but not what they actually said, it was just murmuring sounds. It tortured me because I kept wondering what is the big secret, why can’t I know? So I imagined what it might be they were saying.

Not just for that reason though. I really don’t want to be stuck having only thoughts with no movement, I can assure you it’s horrible not to be able to move or talk. I had a stroke and I’m already paralyzed on one side. I manage but at the same time I’m uncomfortable. I sure as hell don’t want to be affected on my entire body. So I said if that happens don’t save me.

life is about quality, not something you can possibly know until quality is robbed of you. I believe this request is more for the elderly, I’m not that old but at this point I have no desire to be even worse off.

In the case of a baby or child, they have so much life left to live , so they should be saved.

I doubt there are DNR.orders given to children.

originally posted by: violet

I don’t know but I think I’ve requested it and need to clarify what I actually meant. I don’t want to be saved to be left in a coma for years suffering in silence not being able to communicate or move. My choice as I believe you are aware and I’ve already spent too much time in hospitals and I don’t feel I was treated with respect and dignity from staff or family.

For one they think you can’t hear as they do that group nod thing of let’s go into the halfway and talk about her. I could hear the mumbling , but not what they actually said, it was just murmuring sounds. It tortured me because I kept wondering what is the big secret, why can’t I know? So I imagined what it might be they were saying.

Not just for that reason though. I really don’t want to be stuck having only thoughts with no movement, I can assure you it’s horrible not to be able to move or talk. I had a stroke and I’m already paralyzed on one side. I manage but at the same time I’m uncomfortable. I sure as hell don’t want to be affected on my entire body. So I said if that happens don’t save me.

life is about quality, not something you can possibly know until quality is robbed of you. I believe this request is more for the elderly, I’m not that old but at this point I have no desire to be even worse off.

In the case of a baby or child, they have so much life left to live , so they should be saved.

I doubt there are DNR.orders given to children.

Sorry to hear that.
I had a stroke in October.
It can happen to anybody at any given time.