Pt choking and DNR....

[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?

[elkpark]

Nothing. Just keep them comfortable.

What do you consider to be keeping someone "comfortable" when s/he is choking? Choking is certainly not comfortable.

[Been there,done that, ASN, RN]

You must attempt to remove the obstruction. If it is not successful, then the DNR rules would apply.

[jossjjojo]

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.

You're right, the hemlich is not a cardiac life saving technique, but if the item can not be retrieved through the hemlich or through suction and the patient becomes unconscious suffering a respiratory and/or cardiac arrest then the DNR order goes into effect. Why would you want to resuscitate an elderly person with dementia who is a DNR, if their heart stops, it stops, no matter the reason. If I was the patients family and resuscitated my father from a cardiac and/or respiratory arrest I'd be really upset.

You must attempt to remove the obstruction. If it is not successful, then the DNR rules would apply.

Absolutely

[Dazglue, ADN, BSN, MSN, RN]

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.

I feel so sorry for that man. It's not liked he choked on purpose. Obviously he's either disabled or elderly and frail for you to be feeding him but I don't think you should refer to him as a crazy old bastard. Maybe you weren't feeding him fast enough AND giving him to big of chunks. Sorry, just my opinion. KARMA.

[OCNRN63, RN]

Well, if someone calls me a "crazy old beeyotch," I'm not likely to take it as a term of endearment. That was really only one of several troubling aspects of the post, FWIW.

[blondy2061h, MSN, RN]

So once the patient becomes pulseless, is it okay to continue attempting to clear the airway if not already done? Use a bag valve mask?

[mcknis]

If DNR and code, let GOD intervene :)

[traumaRUs, MSN, APRN]

Regardless of how it was meant, to refer to a pt in a disrespectful term is not appropriate. The point could have just as easily been made by stating "and my patient wanted to eat immediately afterwards."

Thanks.

[prettyinblu]

I asked our medical director what does DNR mean because a similar incident happened and he said " If a person's heart and or lungs stop working, you do nothing"

[BabyLady, BSN, RN]

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?

Full Code.

The choking is unrelated to the illness that the DNR was issued for.

This very question was not only a test question in an ethics chapter but it was also in Saunders when I studied for my NCLEX.

DNR's generally do not apply in the operating room either.

[N1colina]

I was wondering the same thing- what is the bed heimlich??

[umcRN, BSN, RN]

Full Code.

The choking is unrelated to the illness that the DNR was issued for.

This very question was not only a test question in an ethics chapter but it was also in Saunders when I studied for my NCLEX.

DNR's generally do not apply in the operating room either.

I was thinking along these lines too, the choking is unrelated to his/her illness. We had a situation at my work where a very sick, terminal patient self extubated and coded. Had this particular patient coded on his own docs and nursing had already pretty much agreed he would be a "soft code", his body was so far gone it wasn't worth the suffering, but the extubation was unrelated to his disease and a full code was done. Later when he did code on his own he was given the max dosage of code drugs, a round of compressions and it was called, it was not as agressive as the previous code had been but he had almost zero heart function and it was time.

While its not fair that he had to suffer the first time around the extubation was unrelated to his disease process and interventions had to be done

I have also heard that hospital policy where I work is that if a child is dnr and parents opt for a surgery then DNR is lifted from the time the surgery starts and for 24 hours thereafter. At that point it is reinstated unless the parents change their minds