Choking and the DNR patient

  1. Curious to hear opinions on this scenario...

    Long term dementia patient. DNR in place. Patient chokes. Heimlich initially unsuccessful and pt codes. What should be done for this patient?
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    Joined: Sep '10; Posts: 4; Likes: 1

    5 Comments

  3. by   jossjjojo
    Quote from Beachbum2010
    Curious to hear opinions on this scenario...

    Long term dementia patient. DNR in place. Patient chokes. Heimlich initially unsuccessful and pt codes. What should be done for this patient?
    I just saw this same question in another area.
  4. by   Beachbum2010
    I am interested to hear the opinions of some adon's and don's please. This is a hypothetical situation, not something that has happened.
    Thanks!
  5. by   pielęgniarka
    911 needs to be called-- All because the pt is DNR does not mean we don't treat an emergent situation. Go to your state dept of health and search for "dnr and choking" it should bring up some previous investigations or reports on places for that.
  6. by   lorjie
    unsuccessful heimlich that results in a code is still a code, regardless of what precipitated it. say for instance the EMT's arrive and they see no pulse, no respirations and a big fat DNR. you say "but the patient had choked!" they are not going to break out the paddles at that point.... yes, try your hardest to remove the airway obstruction but a code is a code. heart stops, hands off.
  7. by   debRN0417
    It is true that an unsuccessful heimlich will result in a "code" however, a "code" can't be done because you will have a blocked airway and no air exchange. You must still continue to heimlich the person even though they are unresponsive and "down" when the EMS arrives they should try to remove the obstruction because they have laryngoscopes and could possibly do this. I am concerned about the legal ramifications of this because it began as choking- not an arrest situation. I can hear it now..."They let my momma choke to death..." However....on the flip side of that, should you have a severely demented resident who is at risk for such a thing, then a meeting/care plan should be done regarding this a well as a discussion with the family being specific as to "what to do if momma chokes and the heimlich is not effective"...this should be well documented. Many times advanced dementia predisposes to inability/forgetting how to swallow. Choking can happen to anyone, you, me or an 88 year old demented person, but...a DNR does not mean that if I choke you do not try to help. It's not the ones on the aspiration precautions that are the scary ones...it's the ones who are not! Familarize yourself with your facility policy on this.

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