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  #1  
Old 05-23-2012
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Medicolegal and Ethics Ethics Q-Intubate or not

A 65 year old woman with long standing smoking history and COPD is admitted to the hospital with an acute exacerbation, caused by a lung infection. You know her code status to be DNR. During her hospital course, her condition worsens and she becomes delirious. The next day, you're informed by the nursing staff that the patient's O2 sat. is falling rapidly. You examine her and find increased breathing effort. What's the best thing you could do next?
1. Talk to the patients family about end of life care.
2. Use broad spectrum antibiotics and cover for MRSA
3. Proceed to intubate the patient
4. Talk to the family and take consent for intubation and new antibiotic regimen
5. Quarantine the patient
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  #2  
Old 05-23-2012
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Default my answer

I've just started going through ethics&behav but from what I understand pt's status is DNR but it's not DNI. so I would go with:

3. Proceed to intubate the patient

broad-spectrum atbs would be my next step
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Old 05-24-2012
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DNR doesn't stop u from giving antibiotics.

But it does mean we can't intubate, for the purpose of resuscitation. Here the patient has COPD, which is being exasperated by the lung infection, so intubation as part of treatment, I think would be ok.
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  #4  
Old 05-24-2012
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Quote:
Originally Posted by slowpoke View Post
DNR doesn't stop u from giving antibiotics.

But it does mean we can't intubate, for the purpose of resuscitation. Here the patient has COPD, which is being exasperated by the lung infection, so intubation as part of treatment, I think would be ok.
That's what I meant
So my answer to that question as I outlined before is C-intubation.
I mentioned antibiotics as the next step after intubation (in the real life settings, not to give the answer to this particular question - sorry if that was a bit confussing
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Old 05-24-2012
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whats the answer?
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Old 05-24-2012
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Listening

A.Talk to patients family about end of life care...
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Old 05-24-2012
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Quote:
Originally Posted by numbndumb View Post
whats the answer?
I made this question up but my answer would be to intubate. The reason is the same as what the others posted.

Sent from my Desire HD
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Old 05-24-2012
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intubation, CPR and Ventilator will be coming under DNR ...
My opinion differs my friend...
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Old 05-24-2012
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you guys might wanna take a look at sample DNR below...
read the last few lines....
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Ethics Q-Intubate or not-virginia_sample_ddnr.jpg  
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Old 05-24-2012
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Quote:
Originally Posted by one_destiny View Post
intubation, CPR and Ventilator will be coming under DNR ...
My opinion differs my friend...
Intubation is not included in DNR.
There is a DNI form (Do Not Intubate) and it's a separate thing.
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Old 05-24-2012
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I thought Intubation was a part of resuscitation..
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Old 05-24-2012
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Quote:
Originally Posted by numbndumb View Post
I thought Intubation was a part of resuscitation..
DNR and DNI are very different. Read Conrad Fischers 100 cases for this.
You cannot intubate as a part of resuscitation in a DNR patient but you can do it in case of respiratory compromise. For instance you can intubate them during general anesthesia!
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Old 05-24-2012
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Yup, agreed!!
Quote:
Originally Posted by smanthrav View Post
DNR and DNI are very different. Read Conrad Fischers 100 cases for this.
You cannot intubate as a part of resuscitation in a DNR patient but you can do it in case of respiratory compromise. For instance you can intubate them during general anesthesia!
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Old 05-24-2012
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Quote:
Originally Posted by smanthrav View Post
DNR and DNI are very different. Read Conrad Fischers 100 cases for this.
You cannot intubate as a part of resuscitation in a DNR patient but you can do it in case of respiratory compromise. For instance you can intubate them during general anesthesia!
Yeah... is the patient still alive? yes... he hasn't died... this is not a resuscitation procedure.
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