An Interesting Conundrum OR What Patients put Doctors through

[gallahadesquire]

I ran across this article in the New England Journal of Medicine. It's kind of interesting.

 

http://www.nejm.org/doi/full/10.1056/NEJMc1713344?af=R&rss=currentIssue&

[+ Keith30309]

That’s one way of doing it, I suppose.

 

The second reference case regarding the patient with the false positive tattoo makes me go.... wow.

[TruthBTold]

I was not convinced that the ethics officer gave the best advice. A tattoo does not necessarily represent a current wish because to have it removed takes much work. If it were simply a piece of paper being carried in the wallet then I would be more convinced because if the person not wishing to be resuscitated changed his mind all he would have to do is remove the paper and throw it away. If he decided later no longer wanted to be resuscitated it could be put back in. But a tattoo is a much different matter and does not necessarily indicate a present desire.

[+ GregM]

I read that last night. What a predicament. The Dr is damned if he does and damned if he dont. I think I would play it safe and keep the person alive. I have on my records DNR. I've been given 3 chances at life. When it's my time its my time. Dont fight it.

 

Hugs,

Greg

[+ Funguy]

I had a similar case many years ago where the patient wore a gold necklace (like an ID bracelet) which stated DNR. There was a bit of a kerfuffle until we were able to locate his family (fortunately he was known at the hospital so was ID'd).

 

Another case was that of my father - he had myasthenia gravis for many years and was at end-stage pulmonary muscle failure. He had DNR everywhere, in the room, on file, etc. He had a respiratory episode and the intern on the case gave him respiratory support, including having him intubated. 1-2 days later my father demanded the ET tube be removed and he be allowed to pass. All of my family was present and the wishes respected. Fortunately he was medicated and was in no distress at the end.

 

p.s. - @Gar1eth - it was MANY years after he was diagnosed and he was 86 by that time.

[+ nycman]

I'm still trying to figure out how an unconscious drunk...ended up with "hypotension and an anion-gap metabolic acidosis with a pH of 6.81" "several hours later".

 

Can't help but thinking someone missed something.....just saying...that's not a "normal" course.

 

I'm a gigantic supporter of DNR's and self determination. Nonetheless, I think I'd have a hard time honoring a tattoo as much as I'd WANT to.

 

Reminds me of one of my favorite jokes..."no one ever died from getting CPR"......grin

[gallahadesquire]

I'm still trying to figure out how an unconscious drunk...ended up with "hypotension and an anion-gap metabolic acidosis with a pH of 6.81" "several hours later".

 

Can't help but thinking someone missed something.....just saying...that's not a "normal" course.

 

I'm a gigantic supporter of DNR's and self determination. Nonetheless, I think I'd have a hard time honoring a tattoo as much as I'd WANT to.

 

Reminds me of one of my favorite jokes..."no one ever died from getting CPR"......grin

 

I'm not sure that's correct, what with the broken ribs and the heart being substernal. It is certainly possible to inflict some nasty collateral damage with CPR.

[+ sniper]

If someone changed their mind they could get a line through the "not" quite easily. I'm still disturbed about the fact they worked on my mother for a couple of hours before she died because I was under the mistaken impression I needed to be there and didn't realize that the doctor on the phone was asking me but not directly to tell him to tell them to stop.

[+ nycman]

I'm not sure that's correct, what with the broken ribs and the heart being substernal. It is certainly possible to inflict some nasty collateral damage with CPR.

 

You’re thinking with your dorky doctor brain and missing the joke.

 

If a patient is getting CPR...they’re already fucking DEAD.

 

You can’t kill someone twice...ergo....no one ever dies from getting CPR!

 

Unfortunately, like most jokes....once you have to explain them...

 

And yes, you are correct...CPR...when done well...will almost always inflict collateral damage.....dork.

 

Grin

[TruthBTold]

You’re thinking with your dorky doctor brain and missing the joke.

If a patient is getting CPR...they’re already fucking DEAD.

You can’t kill someone twice...ergo....no one ever dies from getting CPR!

Unfortunately, like most jokes....once you have to explain them...

And yes, you are correct...CPR...when done well...will almost always inflict collateral damage.....dork.

Grin

 

Not sure that is true. I am no doctor but I am not sure that a person who will be getting CPR is technically dead. I believe the point is to revive them. If they are revived they have not been dead. If they are not revived then they probably will be.

[gallahadesquire]

That's just the point. Their brain isn't dead, it just isn't working at the moment. And the heart had better be doing SOMETHING because if it's truly flat line, that's bad.

 

Requisite story: When I was a resident, I was called to the ER to intubate someone. He was in full code. I clearly saw his vocal cords, but I didn't hear any breath sounds. Another look ... yeah, in the airway ... no breath sounds.

 

We then looked, and saw that he had post mortem lividity, when the blood pools to the lowest points. He'd been dead a long time. I didn't hear breath sounds because he was in rigor mortis. Yuck.