Case 85 - DNR Flashcards
patient comes for surgery, has a pre-op DNR order, do you suspend it for surgery?
NO
Talk to surgeon, patient, and family about options regarding resuscication efforts in the OR
what should you discuss with the patient and or patient’s surrogate before admin of anesthesia in a DNR patient coming for surgery?
1) discuss with family patient’s goals and wishes
2) anesthesia is an alternate state
- in which many negative physiological effecs can occur due to anesthesia and can be reversed:
- hypotension, high spinal
3) highlight which procedures are essential for anesthesia and surgery, and which are not:
* chest compression, defibrilation, tracheal intubation, admin of resuscitave meds, use of O2, invasive monitoring, bag/mask ventilation
4) discuss when to reinstitute prior DNR/DNI status
what course of action can be taken if anesthesiologist and patient or surgeon cannot come to an agreement?
1) withdraw from case after finding replacement
* anesthesiologist who has conflicting views of his or her morall views can withdraw from case after obtaining a replacement to provide care
2) if elective surgery, contact ethics committee
3) if emergent surgery and no replacement found
- original anesthesiologist must proceed with resonable adherence to patient’s directives
- explain risks of limiting care: such as death