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A short thread on a medical term that is really important for the public to understand.
DNACPR/DNR/NFR
Please #medtwitter feel free to add to/embellish as needed.
Let's start:
Do Not Attempt CardioPulmonary Resuscitation:
DNACPR/DNR/NFR
Please #medtwitter feel free to add to/embellish as needed.
Let's start:
Do Not Attempt CardioPulmonary Resuscitation:
Firstly it must be understood that in NO WAY does a DNACPR order with hold treatment.
Most situations where a DNACPR is appropriate is on patients who are actively being treated for acute conditions and/or exacerbations of their chronic diseases such as cancer or lung disease.
Most situations where a DNACPR is appropriate is on patients who are actively being treated for acute conditions and/or exacerbations of their chronic diseases such as cancer or lung disease.
This means patients still receiving medicines, antibiotics, fluids, O2 and various other therapies and investigations if needed. This also means they'll be nursed in an appropriate ward level care. That could be anything from a general ward, to HDU, to ITU.
If despite all appropriate treatment to allow the body to heal from their acute/chronic condition, the body's systems fail to the point where the heart and lungs stop working, AT THAT POINT, the DNACPR order comes into effect.
It means that CPR in that context is futile.
It means that CPR in that context is futile.
All that happens if CPR is attempted inappropriately in that context is the patient is robbed of any dignity and is brutalised in their last moments, for nothing.
The body has failed to heal with all the effort that's already gone into it.
There is no coming back from that.
The body has failed to heal with all the effort that's already gone into it.
There is no coming back from that.
Advanced Life Support, CPR, and Defibrillation (the bit where they shout CLEAR! and shock you with electricity on TV and movies) only works for very specific forms of cardiac arrest.
It is NOT a cure for normal dying.
Normal dying occurs when the body's self healing stops.
It is NOT a cure for normal dying.
Normal dying occurs when the body's self healing stops.
Even in those where ALS, CPR and Defibrillation does work to restart the heart, it's only a tiny fraction that ever return to their baseline level of function.
Most who "survive" their cardiac arrest, even with perfect response and treatment, simply die later, never waking up.
Most who "survive" their cardiac arrest, even with perfect response and treatment, simply die later, never waking up.
The majority of those who survive will have significant physical & mental injury with which to contend.
No one ever comes back like they show in the movies. The movies never show the months of rehab & multiple complications on the way either.
Again that's only IF they survive.
No one ever comes back like they show in the movies. The movies never show the months of rehab & multiple complications on the way either.
Again that's only IF they survive.
If you are unfortunate enough to suffer from a significant chronic condition, cancer or are frail due to physical disability or age, DNACPR is something you should discuss with your doctor.
Ideally well before any acute illness or hospital admission. #havetheconversation
Ideally well before any acute illness or hospital admission. #havetheconversation
If you are a doctor reading this, please discuss DNACPR with ALL your adult patients.
As an Emergency Medicine doctor it shouldn't be me or my colleagues bringing this up with your patients when they're acutely unwell, but too often it is.
#havetheconversation
As an Emergency Medicine doctor it shouldn't be me or my colleagues bringing this up with your patients when they're acutely unwell, but too often it is.
#havetheconversation
No one should have to #havetheconversation in the Emergency Department, but we do.
We EM docs have become good at it through necessity rather than through choice.
We EM docs have become good at it through necessity rather than through choice.
Ultimately the decision in the UK around DNACPR is a medical one. It's the responsibility of the attending physician to make a decision regarding the appropriateness of CPR and to inform the patient and relatives as to the reasoning.
I have never once, not in 18 years, have had a patient/family disagree with a decision. That's not because I'm a genius, but because I take the time to #havetheconversation & make people understand why I made the decision.
Patients are reasonable, even if they're often scared.
Patients are reasonable, even if they're often scared.
I also understand why my colleagues defer the decision to discuss DNACPR with their patients in clinics or at their practice. It's not something pleasant or cheerful. Yet it can be vitally important.
It's part of the job. A responsibility. Now more than ever.
It's part of the job. A responsibility. Now more than ever.
Finally I would like to assure patients. I'll always do everything right by YOU. Not right for me, the staff, the health board, the government, your family.
I will only ever do what's right for YOU.
Sometimes that means everything.
Other times that means knowing when to stop.
I will only ever do what's right for YOU.
Sometimes that means everything.
Other times that means knowing when to stop.
