Pt choking and DNR....

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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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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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What type of setting is this in?

We know that DNR doesn't mean do not treat. That said, in ltc, I would start the heilmich and would have called 911. As soon as 911 would come, then they would be a full code if they code? Hmmmm. Never had this happen before..

I can't wait to read the replies to follow.

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Specializes in Cardiology.
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?

If the patient codes for whatever reason and they are a DNR then do not resuscitate. I would do the heimlich, suction, whatever I could but once they "code" it's time to stop treatment.

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Specializes in Cardiology.
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.

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Nothing. Just keep them comfortable.

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Specializes in Trauma Surgical ICU.

No matter the reason, if they code it is now out of our hands; we can not do CPR..

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yes.....DNR is JUST the CPR for pulseless residents. So if they are a DNR then NO CPR. The Heimlich is NOTa cardiac event and should be done. If the person BECOMES pulseless while doing the heimlich the you do not give CPR if they are a DNR.

One thing to keep in mind that I found as the staff educator for a LTC facility is this--you would be suprised how often here in NY state where we use BRIGHT PINK MOLST forms that someone will see the form in the chart (Can't miss that pink! lol) and assume that just the form being there means a resident is DNR. ALL residents are required to have a MOLST form here and it only gives info on the residents wishes....to be DNR or NOT. DNI or not, level of care desired, etc.

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Great scenario discussion, thank you.

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I had this almost happen to me once, it was scary. I keep doing the bed Heimlich, to little success. And just when it was looking like we were either going to have to switch to CPR or stop PEWY a piece of scrambled eggs shots out and we hear a big recovery breathe.

It was too damn scary. Can you believe the patient wanted me to start feeding him almost immediately after and then was complaining I was going to slow?

The morale of the story is don't feed your patients too fast no matter what they say.

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Specializes in LTC.

I performed the helmich on a DNR dementia resident. I then called 911 and they did further tx. The helmich is not a form of cardiac life saving techniques.

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Specializes in LTC.
I had this almost happen to me once, it was scary. I keep doing the bed Heimlich, to little success. And just when it was looking like we were either going to have to switch to CPR or stop PEWY a piece of scrambled eggs shots out and we hear a big recovery breathe.

It was too damn scary. Can you believe the pt wanted me to start feeding him almost immediately after and then was complaining I was going to slow?

The morale of the story is don't feed your patients too fast no matter what they say.

What is the bed heimlich?

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