Category Archives: Do Not Resuscitate (DNR)

Question: There is certainly a lot of confusion that remains in regards to DNR's. From your replies, I get the impression that if someone is breathing, has a pulse and a valid DNR, but has respiratory or cardiac problems which may or may not be corrected with artificial ventilation, assisted ventilation without an artificial airway (conscious CHF)or chest compressions we are to provide NRB O2, symptom relief meds and comfort measures. That being said, if someone has a valid DNR becomes obstructed with a FB, we have been instructed by BH personnel to attempt to clear the FB and if death results in the process, validate the DNR and stop the efforts. If this is correct, are we not providing or at least attempting to provide A/R in one of the steps to alleviate the obstruction? This would be in contraindication to past answers which the committee has provided. Not trying to be a pain, just looking for clarity for viewers and myself. Great site – your time and effort is appreciated.

Question: Patient is unconscious respirations of 8 but DNR is present. We can't assist respirations using a BVM? Sorry if this question had already been asked / answered.

Question: This question is regarding not giving Narcan to a DNR patient. Obviously, if there is not an underlining medical issue (e.g. terminal CA) and a patient ODs, even with a DNR, we attempt to reverse any issues. However, if the patient does have a medical issue with a DNR, has decided to OD to commit suicide and is in a pre-arrest / arrested state, is it reasonable to assume that since they are breaking the law, that the DNR can no longer be valid?

Question: If a patient meets the protocol for having CPAP treatment but they have a valid DNR Confirmation Form can a PCP still administer CPAP?

Question: If a patient has a valid DNR, can they still fall under the Stroke Protocol? I realize the protocol's contraindications list a palliative patient or terminally ill but does not address DNR. DNR in my point of view only applies to a patient who is dead, and wishes to not be resuscitated. Treatment for stroke at a proper facility could restore the patient's quality of life if such is affected by the stroke, and I feel they should still be included. I just wanted to verify.

Question: On a recent call, we transported a patient from a nursing home with a valid MOHLTC DNR. In the middle of all the paperwork was a nursing home DNR with level 1, level 2, and there was a check mark that the patient did not want to decide on a DNR status at this time. The MOHLTC DNR was dated in 2009 and the nursing home DNR was dated 2010. Do we respect the valid MOHLTC DNR or the nursing home DNR dated later?

Question: I would like to go back to the DNR ventilation question from Sept 4th. The way I understand your answer is that there is no difference between Assisted ventilations and Artificial ventilations in regards to a DNR; Both are inappropriate if a DNR is present, even if the patient has spontaneous respirations. I am interpreting your answer correctly?

Question: A patient requires assisted ventilations via BVM for shortness of breath for CHF or for exacerbated asthma, can we assisted ventilations for this patient. I understand that we cannot perform artificial respirations for a patient who is apneic, but can we assist ventilations with a patient who is conscious and breathing on their own, but needs assistance? Patient has a valid DNR.

Question: Just some clarification in regards to DNR's. If a patient is having an episode of an exacerbated Asthma and has a valid DNR, do we administer Epi for the asthma? I understand that we cannot "bag" the Patient due to the DNR status.

Question: I have recently received an ACR audit, and have spoken to others, within my service, who have received audits as well, stating that a DNR patient who has not arrested should be ventilated via BVM. Everyone is under the impression that a DNR patient should not be bagged. I know that I have had previous conversations with SWORBHP educators in which the final word on this subject had been no BVM in the presence of a DNR irregardless of whether then patient was VSA or pre-arrest. A similar question on this issue was previously asked and answered on 1-March-2012 with the resulting answer being "therefore, to answer your question, if a valid DNR form is available, none of these "advanced cardiopulmonary resuscitation" procedures should be initiated, period. The SWORBHP medical directors would suggest that this is independent of whether or not the patient has completely arrested or not". The question now is what is the right thing to do? What we have previously been told is right or what the auditors are now saying we should be doing? Could you please shed some light on the situation because there's once again a lot of confusion surrounding the correct application of the DNR. Thanks.

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