Resuscitation Orders
Cardiopulmonary Resuscitation
Heart Arrest
Fluid Therapy
Heart Massage
Trustees
Trauma Centers
Encyclopedias as Topic
Academic Medical Centers
Societies, Hospital
Libraries, Hospital
The timing of do-not-resuscitate orders and hospital costs. (1/212)
The relation between the timing of do-not-resuscitate (DNR) orders and the cost of medical care is not well understood. This prospective observational study compares hospital costs and length of stay of 265 terminally ill patients with admission DNR orders, delayed DNR orders (occurring after 24 hours), or no DNR orders (full code). Patients whose orders remained full code throughout a hospital stay had similar lengths of stay, total hospital costs, and daily costs as patients with admission DNR orders. Patients with delayed DNR orders, by contrast, had a greater mortality, longer length of stay, and higher total costs than full code or admission DNR patients, but similar daily costs. The causes of delay in DNR orders and the associated higher costs are a matter for future research. (+info)A staff dialogue on do not resuscitate orders: psychosocial issues faced by patients, their families, and caregivers. (2/212)
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery which provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The following case of a woman who developed lymphoma was discussed at the July and August, 1997 Schwartz Center Rounds. There were considerable delays and uncertainties in the diagnosis, which was followed by an unpredictably chaotic clinical course. Although she had made it clear to her doctor that she did not want "heroic measures," she had unexpectedly rallied so many times that her son and her husband wanted her doctors to do everything possible to keep her alive, including the performance of cardiopulmonary resuscitation (CPR). The clinical benefit of CPR in the event of cardiac arrest in those with cancer is discussed, as are do not resuscitate (DNR) orders, living wills, and healthcare proxies. In addition, the issues that surround DNR status, including who should discuss DNR status with a patient, and how and when it should be discussed, are reviewed. Staff raised concerns about the effect of discussing DNR status on the doctor-patient relationship, and wondered whether writing DNR orders adversely affect the care of patients. (+info)The status of the do-not-resuscitate order in Chinese clinical trial patients in a cancer centre. (3/212)
OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (+info)Response of paramedics to terminally ill patients with cardiac arrest: an ethical dilemma. (4/212)
BACKGROUND: In an environment characterized by cuts to health care, hospital closures, increasing reliance on home care and an aging population, more terminally ill patients are choosing to die at home. The authors sought to determine the care received by these patients when paramedics were summoned by a 911 call and to document whether do-not-resuscitate (DNR) requests influenced the care given. METHODS: The records of a large urban emergency medical services system were reviewed to identify consecutive patients with cardiac arrest over the 10-month period November 1996 to August 1997. Data were abstracted from paramedics' ambulance call reports according to a standardized template. The proportion of these patients described as having a terminal illness was determined, as was the proportion of terminally ill patients with a DNR request. The resuscitative efforts of paramedics were compared for patients with and without a DNR request. RESULTS: Of the 1534 cardiac arrests, 144 (9.4%) involved patients described as having a terminal illness. The mean age of the patients was 72.2 (standard deviation 14.8) years. Paramedics encountered a DNR request in 90 (62.5%) of these cases. Current regulations governing paramedic practice were not followed in 34 (23.6%) of the cases. There was no difference in the likelihood that cardiopulmonary resuscitation (CPR) would be initiated between patients with and those without a DNR request (73% v. 83%; p = 0.17). In patients for whom CPR was initiated, paramedics were much more likely to withhold full advanced cardiac life support if there was a DNR request than if there was not (22% v. 68%; p < 0.001). INTERPRETATION: Paramedics are frequently called to attend terminally ill patients with cardiac arrest. Current regulations are a source of conflict between the paramedic's duty to treat and the patient's right to limit resuscitative efforts at the time of death. (+info)CPR or DNR? End-of-life decision making on a family practice teaching ward. (5/212)
OBJECTIVE: To determine the proportion of patients on a family practice ward who had "code status" orders and end-of-life discussions documented on their charts in the first week of admission. To examine the correlation between a tool predicting the likelihood of benefit from cardiopulmonary resuscitation (CPR) and actual end-of-life decisions made by family physicians and their patients. DESIGN: Cross-sectional descriptive study using a retrospective chart review. SETTING: A 14-bed teaching ward where family physicians admit and manage their own patients in an urban tertiary care teaching hospital. PARTICIPANTS: Patients admitted to the ward for 7 or more days between December 1, 1995, and August 31, 1996. MAIN OUTCOME MEASURES: Frequency of documented "do not resuscitate" (DNR) or "full code" orders and documented end-of-life discussions. Prognosis-after-resuscitation (PAR) score. RESULTS: In the 103 charts reviewed, code status orders were entered within 7 days for 60 patients (58%); 31 were DNR, and 29 were full code. Discussion of code status was documented in 25% of charts. The PAR score for 40% of patients was higher than 5, indicating they were unlikely to survive to discharge from hospital should they require CPR. There was a significant association between PAR scores done retrospectively and actual code status decisions made by attending family physicians (P < .005). CONCLUSIONS: End-of-life discussions and decisions were not fully documented in patients' charts, even though patients were being cared for in hospital by their family physicians. A PAR score obtained during the first week of admission could assist physicians in discussing end-of-life orders with their patients. (+info)A physician's guide to talking about end-of-life care. (6/212)
A large majority of patients and close family members are interested in discussing end-of-life issues with their physician. Most expect their physician to initiate such dialogue. End-of-life discussions, however, must go beyond the narrow focus of resuscitation. Instead, such discussions should address the broad array of concerns shared by most dying patients and families: fears about dying, understanding prognosis, achieving important end-of-life goals, and attending to physical needs. Good communication can facilitate the development of a comprehensive treatment plan that is medically sound and concordant with the patient's wishes and values. This paper presents a practical 4-step approach to conducting end-of-life discussions with patients and their families: (1) Initiating Discussion, (2) Clarifying Prognosis, (3) Identifying End-of-Life Goals, and (4) Developing a Treatment Plan. By following these 4 steps, communication can be enhanced, fears allayed, pain and suffering minimized, and most end-of-life issues resolved comfortably, without conflict. (+info)Treatment of acute myocardial infarction and 30-day mortality among women and men. (7/212)
BACKGROUND: Previous studies have suggested that women with acute myocardial infarction receive less aggressive therapy than men. We used data from the Cooperative Cardiovascular Project to determine whether women and men who were ideal candidates for therapy after acute myocardial infarction were treated differently. METHODS: Information was abstracted from the charts of 138,956 Medicare beneficiaries (49 percent of them women) who had an acute myocardial infarction in 1994 or 1995. Multivariate analysis was used to assess differences between women and men in the medications administered, the procedures used, the assignment of do-not-resuscitate status, and 30-day mortality. RESULTS: Among ideal candidates for therapy, women in all age groups were less likely to undergo diagnostic catheterization than men. The difference was especially pronounced among older women; for a woman 85 years of age or older, the adjusted relative risk was 0.75 (95 percent confidence interval, 0.68 to 0.83). Women were somewhat less likely than men to receive thrombolytic therapy within 60 minutes (adjusted relative risk, 0.93; 95 percent confidence interval, 0.90 to 0.96) or to receive aspirin within 24 hours after arrival at the hospital (adjusted relative risk, 0.96; 95 percent confidence interval, 0.95 to 0.97), but they were equally likely to receive beta-blockers (adjusted relative risk, 0.99; 95 percent confidence interval, 0.95 to 1.03) and somewhat more likely to receive angiotensin-converting-enzyme inhibitors (adjusted relative risk, 1.05; 95 percent confidence interval, 1.02 to 1.08). Women were more likely than men to have a do-not-resuscitate order in their records (adjusted relative risk, 1.26; 95 percent confidence interval, 1.22 to 1.29). After adjustment, women and men had similar 30-day mortality rates (hazard ratio, 1.02; 95 percent confidence interval, 0.99 to 1.04). CONCLUSIONS: As compared with men, women receive somewhat less aggressive treatment during the early management of acute myocardial infarction. However, many of these differences are small, and there is no apparent effect on early mortality. (+info)Withholding and withdrawing life-sustaining treatment. (8/212)
Withholding or withdrawing life-sustaining therapies is ethical and medically appropriate in some circumstances. This article summarizes the American Medical Association's Education for Physicians on End-of-life Care (EPEC) curriculum module on withholding or withdrawing therapy. Before reviewing specific treatment preferences, it is useful to ask patients about their understanding of the illness and to discuss their values and general goals of care. Family physicians should feel free to provide specific advice to patients and families struggling with these decisions. Patients with decision-making capacity can opt to forego any medical intervention, including artificial nutrition/hydration and cardiopulmonary resuscitation. (+info)Resuscitation orders, also known as do-not-resuscitate (DNR) orders or no-code orders, are medical instructions written by a physician in the chart of a patient who has a serious illness or chronic health condition and for whom cardiopulmonary resuscitation (CPR) would be medically inappropriate.
The order specifies that if the patient's heart stops or they stop breathing, healthcare providers should not attempt to restart it using CPR or other advanced life support measures. Instead, comfort care measures are provided to keep the patient as comfortable and pain-free as possible.
Resuscitation orders are typically discussed with the patient, their family members, and their healthcare team, taking into account the patient's values, goals, and treatment preferences. The decision to implement a resuscitation order is based on an assessment of the patient's overall prognosis, likelihood of survival, and quality of life.
Resuscitation is a medical term that refers to the process of reversing cardiopulmonary arrest or preventing further deterioration of someone in cardiac or respiratory arrest. It involves a series of interventions aimed at restoring spontaneous blood circulation and breathing, thereby preventing or minimizing tissue damage due to lack of oxygen.
The most common form of resuscitation is cardiopulmonary resuscitation (CPR), which combines chest compressions to manually pump blood through the body with rescue breaths to provide oxygen to the lungs. In a hospital setting, more advanced techniques such as defibrillation, medication administration, and intubation may also be used as part of the resuscitation process.
The goal of resuscitation is to stabilize the patient's condition and prevent further harm while treating the underlying cause of the arrest. Successful resuscitation can lead to a full recovery or, in some cases, result in varying degrees of neurological impairment depending on the severity and duration of the cardiac or respiratory arrest.
Medical records are organized, detailed collections of information about a patient's health history, including their symptoms, diagnoses, treatments, medications, test results, and any other relevant data. These records are created and maintained by healthcare professionals during the course of providing medical care and serve as an essential tool for continuity, communication, and decision-making in healthcare. They may exist in paper form, electronic health records (EHRs), or a combination of both. Medical records also play a critical role in research, quality improvement, public health, reimbursement, and legal proceedings.
Cardiopulmonary resuscitation (CPR) is a lifesaving procedure that is performed when someone's breathing or heartbeat has stopped. It involves a series of steps that are designed to manually pump blood through the body and maintain the flow of oxygen to the brain until advanced medical treatment can be provided.
CPR typically involves a combination of chest compressions and rescue breaths, which are delivered in a specific rhythm and frequency. The goal is to maintain circulation and oxygenation of vital organs, particularly the brain, until advanced life support measures such as defibrillation or medication can be administered.
Chest compressions are used to manually pump blood through the heart and into the rest of the body. This is typically done by placing both hands on the lower half of the chest and pressing down with enough force to compress the chest by about 2 inches. The compressions should be delivered at a rate of at least 100-120 compressions per minute.
Rescue breaths are used to provide oxygen to the lungs and maintain oxygenation of the body's tissues. This is typically done by pinching the nose shut, creating a seal around the person's mouth with your own, and blowing in enough air to make the chest rise. The breath should be delivered over about one second, and this process should be repeated until the person begins to breathe on their own or advanced medical help arrives.
CPR can be performed by trained laypeople as well as healthcare professionals. It is an important skill that can help save lives in emergency situations where a person's breathing or heartbeat has stopped.
Cardiac arrest, also known as heart arrest, is a medical condition where the heart suddenly stops beating or functioning properly. This results in the cessation of blood flow to the rest of the body, including the brain, leading to loss of consciousness and pulse. Cardiac arrest is often caused by electrical disturbances in the heart that disrupt its normal rhythm, known as arrhythmias. If not treated immediately with cardiopulmonary resuscitation (CPR) and defibrillation, it can lead to death or permanent brain damage due to lack of oxygen supply. It's important to note that a heart attack is different from cardiac arrest; a heart attack occurs when blood flow to a part of the heart is blocked, often by a clot, causing damage to the heart muscle, but the heart continues to beat. However, a heart attack can sometimes trigger a cardiac arrest.
Hemorrhagic shock is a type of shock that occurs when there is significant blood loss leading to inadequate perfusion of tissues and organs. It is characterized by hypovolemia (low blood volume), hypotension (low blood pressure), tachycardia (rapid heart rate), and decreased urine output. Hemorrhagic shock can be classified into four stages based on the amount of blood loss and hemodynamic changes. In severe cases, it can lead to multi-organ dysfunction and death if not treated promptly and effectively.
Fluid therapy, in a medical context, refers to the administration of fluids into a patient's circulatory system for various therapeutic purposes. This can be done intravenously (through a vein), intraosseously (through a bone), or subcutaneously (under the skin). The goal of fluid therapy is to correct or prevent imbalances in the body's fluids and electrolytes, maintain or restore blood volume, and support organ function.
The types of fluids used in fluid therapy can include crystalloids (which contain electrolytes and water) and colloids (which contain larger molecules like proteins). The choice of fluid depends on the patient's specific needs and condition. Fluid therapy is commonly used in the treatment of dehydration, shock, sepsis, trauma, surgery, and other medical conditions that can affect the body's fluid balance.
Proper administration of fluid therapy requires careful monitoring of the patient's vital signs, urine output, electrolyte levels, and overall clinical status to ensure that the therapy is effective and safe.
Heart massage, also known as cardiac massage or chest compression, is a medical procedure that involves applying pressure to the chest in order to manually pump blood through the heart and maintain circulation when the heart has stopped or is not functioning effectively. This is a critical component of cardiopulmonary resuscitation (CPR) and is typically performed during a cardiac arrest to help restore proper blood flow to vital organs and tissues.
During heart massage, the rescuer places their hands on the lower half of the victim's chest, typically at the center, and presses down with the heel of one or both hands. The recommended compression depth for adults is at least 2 inches (5 cm) and should be performed at a rate of 100-120 compressions per minute. It is essential to minimize interruptions in chest compressions and ensure that they are deep and fast enough to maintain adequate blood flow.
Heart massage can also be performed surgically during specific medical procedures, such as open-heart surgery or extracorporeal membrane oxygenation (ECMO). In these cases, the surgeon directly compresses the heart using their hands or specialized instruments. This technique is called a "surgical heart massage" or "direct cardiac compression."
It's important to note that heart massage should only be performed by trained individuals, as improper techniques can cause harm and potentially worsen the patient's condition.
I apologize for any confusion, but "trustees" is not a medical term. In general terms, trustees are individuals or entities appointed to manage and distribute the assets held in a trust for the benefit of the beneficiaries, according to the terms of the trust agreement. The duties and responsibilities of a trustee may include managing investments, filing tax returns, keeping records, and distributing income and principal to the beneficiaries. Trustees are often appointed in estate planning to manage assets for the benefit of heirs or to carry out charitable purposes.
A Trauma Center is a hospital that has specialized resources and capabilities to provide comprehensive care for severely injured patients. It is a designated facility that has met strict criteria established by the American College of Surgeons (ACS) and/or state or regional trauma systems. These criteria include having a dedicated trauma team, available 24/7, with specially trained healthcare professionals who can promptly assess, resuscitate, operate, and provide critical care to patients suffering from traumatic injuries.
Trauma centers are categorized into levels (I-V), based on the resources and capabilities they offer. Level I trauma centers have the highest level of resources and are capable of providing comprehensive care for all types of traumatic injuries, including conducting research and offering education in trauma care. In contrast, lower-level trauma centers may not have the same extent of resources but still provide essential trauma care services to their communities.
The primary goal of a trauma center is to ensure that severely injured patients receive prompt, high-quality care to minimize the risk of complications, reduce long-term disability, and improve overall outcomes.
An encyclopedia is a comprehensive reference work containing articles on various topics, usually arranged in alphabetical order. In the context of medicine, a medical encyclopedia is a collection of articles that provide information about a wide range of medical topics, including diseases and conditions, treatments, tests, procedures, and anatomy and physiology. Medical encyclopedias may be published in print or electronic formats and are often used as a starting point for researching medical topics. They can provide reliable and accurate information on medical subjects, making them useful resources for healthcare professionals, students, and patients alike. Some well-known examples of medical encyclopedias include the Merck Manual and the Stedman's Medical Dictionary.
Academic medical centers (AMCs) are institutions that combine medical care, research, and education in a single setting. They are typically affiliated with a medical school and often serve as teaching hospitals for medical students, residents, and fellows. AMCs are dedicated to providing high-quality patient care while also advancing medical knowledge through research and training the next generation of healthcare professionals.
AMCs often have a strong focus on cutting-edge medical technology, innovative treatments, and clinical trials. They may also be involved in community outreach programs and provide specialized care for complex medical conditions that may not be available at other hospitals or healthcare facilities. Additionally, AMCs often have robust research programs focused on developing new drugs, therapies, and medical devices to improve patient outcomes and advance the field of medicine.
Overall, academic medical centers play a critical role in advancing medical knowledge, improving patient care, and training future healthcare professionals.
A "Hospital Society" is not a medical term per se, but rather a term used to describe an organization or group that operates, supports, and governs a hospital or multiple hospitals. These societies are often non-profit organizations made up of community members, medical professionals, and other stakeholders who work together to ensure the provision of high-quality healthcare services to the community they serve.
The primary goals of Hospital Societies include:
1. Fundraising and resource development to support hospital operations, capital projects, and charitable care programs.
2. Advocating for the hospital and its mission within the community and at various levels of government.
3. Providing governance and oversight through a board of directors or trustees, ensuring that the hospital meets regulatory requirements and maintains high ethical standards.
4. Supporting medical education and research initiatives to advance healthcare knowledge and improve patient care.
5. Fostering community engagement and partnerships to address local health needs and promote wellness.
Examples of Hospital Societies include foundations, auxiliaries, volunteer organizations, and religious or charitable groups that have a vested interest in the success and sustainability of hospitals and healthcare services within their communities.
A hospital library, also known as a health sciences library or medical library, is a type of specialized library that serves the information needs of healthcare professionals, patients, students, and researchers in a hospital or healthcare facility. These libraries typically contain a wide range of resources related to medicine, nursing, allied health professions, and healthcare administration.
The resources available in a hospital library may include:
1. Print materials such as medical textbooks, journals, reference books, and patient education materials.
2. Electronic resources such as e-books, electronic journals, databases, and multimedia resources.
3. Audiovisual materials such as DVDs, CDs, and streaming media related to medical education and patient care.
4. Clinical decision support tools that help healthcare professionals make informed clinical decisions at the point of care.
5. Access to online learning platforms and continuing education resources for healthcare professionals.
6. Services such as literature searching, document delivery, interlibrary loan, and reference assistance.
Hospital libraries play a critical role in supporting patient care, medical education, research, and evidence-based practice in healthcare facilities. They provide access to high-quality, reliable information that helps healthcare professionals make informed decisions about patient care, stay up-to-date with the latest research and best practices, and improve their knowledge and skills. Hospital libraries also provide resources and services that help patients and their families make informed decisions about their health and treatment options.
A "Teaching Hospital" is a healthcare institution that provides medical education and training to future healthcare professionals, such as medical students, residents, and fellows. These hospitals are often affiliated with medical schools or universities and have a strong focus on research and innovation in addition to patient care. They typically have a larger staff of specialized doctors and medical professionals who can provide comprehensive care for complex and rare medical conditions. Teaching hospitals also serve as important resources for their communities, providing access to advanced medical treatments and contributing to the development of new healthcare technologies and practices.
Addenbrooke's Hospital
Do not resuscitate
Life support
Vial of Life
ReSPECT process
Physician Orders for Life-Sustaining Treatment
The League of Youth
Cardiopulmonary resuscitation
Nursing home
Medical Orders for Life-Sustaining Treatment
Neonatal resuscitation
List of Neighbours characters (2008)
ABC (medicine)
List of MeSH codes (E02)
Antonio Puerta
Dying
List of MeSH codes (N02)
DNA (disambiguation)
Combat medical technician
Cardiac Arrest (TV series)
Slow code
Allow natural death
Emergency Preservation and Resuscitation
MedicAlert
Dragiša Gudelj
Pulmonary hypoplasia
Domenico Ghirlandaio
Mental capacity in England and Wales
Advanced trauma life support
Certified anesthesiologist assistant
DNAR17
- The Court of Appeal has stated that a statement in a patient's medical notes that resuscitation should not be attempted (a "Do Not Attempt Resuscitation" Order (DNAR)), should usually only be inserted after consultation with the patient: see R (Tracey) v Cambridge University Hospitals NHS Foundation Trust and others. (innertemplelibrary.com)
- Orders not to attempt resuscitation (DNAR orders) direct the health care team to withhold resuscitative measures in accord with a patient's wishes. (ama-assn.org)
- DNAR orders can be appropriate for any patient medically at risk of cardiopulmonary arrest, regardless of the patient's age or whether or not the patient is terminally ill. (ama-assn.org)
- DNAR orders apply in any care setting, in or out of hospital, within the constraints of applicable law. (ama-assn.org)
- In the event a patient suffers a cardiopulmonary arrest when there is no DNAR order in the medical record, resuscitation should be attempted if it is medically appropriate. (ama-assn.org)
- The DNAR order should be tailored to reflect the particular patient's preferences and clinical circumstances. (ama-assn.org)
- Reinforce with the patient, loved ones, and the health care team that DNAR orders apply only to resuscitative interventions as they relate to the patient's goals for care. (ama-assn.org)
- Confirm whether the patient wants the DNAR order to remain in effect when obtaining consent for surgical or other interventions that carry a known risk for cardiopulmonary arrest and adhere to those wishes. (ama-assn.org)
- Seek consultation with an ethics committee or other appropriate institutional resource if disagreement about a DNAR order that cannot be resolved at the bedside. (ama-assn.org)
- A unilateral do not attempt resuscitation (DNAR) order is written by a physician without permission or assent from the patient or the patient's surrogate decision-maker. (omeka.net)
- Potential justifications for the use of DNAR orders in pediatrics include the belief that attempted resuscitation offers no benefit to the patient or that the burdens would far outweigh the potential benefits. (omeka.net)
- Unilateral DNAR orders might be motivated in part by the moral distress caregivers sometimes experience when feeling forced by parents to participate in interventions that they believe are useless or cruel. (omeka.net)
- There are, however, several risks inherent in unilateral DNAR orders, such as overestimating one's ability to prognosticate or giving undue weight to the physician's values over those of parents, particularly with regard to predicted disability and quality of life. (omeka.net)
- Arguments in favor of, and opposed to, the use of unilateral DNAR orders are presented. (omeka.net)
- In some settings, particularly when death is imminent regardless of whether resuscitation is attempted, unilateral DNAR orders should be viewed as an ethically permissible approach. (omeka.net)
- Yesterday's Daily Telegraph reported that, according to NHS nurses, too many patients are being subjected to Do Not Attempt Resuscitation (DNAR) orders without families being told. (sueryder.org)
- Do not attempt resuscitation (DNAR/DNR), a short thread. (compassionindying.org.uk)
Successful resuscitation2
- Cardiopulmonary resuscitation (CPR) using closed-chest cardiac massage technique was first used in 1960 by Kouwenhoven in 17 patients with cardiac asystole and 3 patients with ventricular fibrillation, with a successful resuscitation in 14 patients (70%) [ 1 ]. (hindawi.com)
- Because overriding a patient's DNR wish violates the right of self-determination, a reasonable rule is to require the surgeon and/or anesthesiologist to discuss preoperatively the increased risk of a cardiac arrest during surgery, as well as the markedly improved chance of a successful resuscitation. (the-hospitalist.org)
DNACPR5
- In the past few weeks we've seen a huge amount of concern that blanket DNACPR (do not attempt cardiopulmonary resuscitation) decisions are being imposed on people without discussing this with them. (compassionindying.org.uk)
- A thread on DNACPR (Do Not Attempt Cardiopulmonary Resuscitation). (compassionindying.org.uk)
- Objectives Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) discussions with patients and their caregivers have been subjected to intense ethical and legal debate in recent years. (bmj.com)
- Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decision making has been the subject of much ethical debate, legal dispute and uncertainty in the last few years. (bmj.com)
- Lawyers acting for her family have described it as a "landmark judgment" clarifying that NHS trusts have a legal duty to tell patients with mental capacity that a Do Not Attempt Cardiac Pulmonary Resuscitation (DNACPR) order has been placed on their medical records - and to involve them in the decision-making process. (cbc-network.org)
Automated External Defi1
- Cardiopulmonary resuscitation (CPR)/ Automated External Defibrillator (AED) certification is required in order to sit for your exams and is not included in this course. (ccp.edu)
20202
- On November 15, 2020, MDHHS issued an order enacting protections to slow the high and rapidly increasing rate of spread of COVID-19. (michigan.gov)
- Guidelines 2021 are based on the International Liaison Committee on Resuscitation 2020 Consensus on Science and Treatment Recommendations and the European Resuscitation Council Guidelines for Resuscitation (2021). (resus.org.uk)
Withhold2
- 8) The hospice care team may withhold or withdraw cardiopulmonary resuscitation if presented with an order not to resuscitate executed pursuant to s. 401.45 . (flsenate.gov)
- D. If this patient's Florida Department of Health out-of-hospital DNR order confirms his DNR preference, then it is appropriate to withhold resuscitation. (the-hospitalist.org)
Prognosis3
- Document in the medical record the patient's clinical status, prognosis, current decision-making capacity, and preferences with respect to resuscitation, as well as the physician's medical judgment about the appropriateness of resuscitation. (ama-assn.org)
- Despite this overall poor prognosis, multiple cases of successful prolonged resuscitation with neurologically intact survival have been reported. (hindawi.com)
- This article also provides practical guidelines for the use of DNR orders, including specific information regarding prognosis, to help physicians carry out discussions with patients and families. (encyclopedia.com)
Interventions4
- I will further argue that our attempts to define futility as a measure of poor utility have "muddied the waters" in ethical decision making in resuscitation medicine to such an extent that at times we are providing resuscitation interventions which bring about more harm than good. (bmj.com)
- In addition to the 2021 guidelines, Resuscitation Council UK has a number of quality standards, publications, public and professional resources to which people should refer when designing and implementing interventions to improve cardiac arrest outcomes. (resus.org.uk)
- In 1991, approximately 15% of patients with DNR orders had a surgical procedure, with most interventions targeting comfort and/or nursing care. (the-hospitalist.org)
- Delays occurred in hospital admission, assessment of patients, initiation of resuscitation, initiation of medical or surgical interventions, ordering blood, receipt of blood and administration of blood to patients. (who.int)
Patient's medical1
- If there is no DNR physician's order present in a hospitalized patient's medical chart, the medical staff is bound (by medical and legal regulations, as well as professional ethical standards) to employ CPR, mechanical ventilation, and other life-saving techniques and equipment in the event of cardiac or respiratory failure. (encyclopedia.com)
Resuscitative efforts1
- If it is found after the code is initiated that the patient would not have wanted resuscitation, the attending physician should order that resuscitative efforts be stopped. (ama-assn.org)
Decisions3
- Revisit and revise decisions about resuscitation-with appropriate documentation in the medical record-as the patient's clinical circumstances change. (ama-assn.org)
- Revisit with the surrogate decisions about resuscitation as the patient's clinical circumstances change, revising the decision as needed and updating the medical record accordingly. (ama-assn.org)
- Although often thought of primarily for terminally ill patients or those with chronic medical conditions, advance care planning is valuable for everyone, in order to ensure that their own values, goals, and preferences will inform care decisions when they cannot speak for themselves. (ama-assn.org)
Cardiac arrest2
- In one large study, the overall median duration of resuscitation for in-hospital cardiac arrest was 17 minutes with an interquartile range of 10-26 min [ 3 ]. (hindawi.com)
- When a terminally ill patient with a DNR order undergoes surgery, how should physicians deal with the patient's no-code status, especially if an iatrogenic cardiac arrest should occur? (the-hospitalist.org)
Physician3
- If the patient has an advance directive, the physician should review the directive with the patient and confirm that the preferences set out in the directive about resuscitation are current and valid. (ama-assn.org)
- When the patient's preferences cannot be determined and the individual has no surrogate, the physician should consult with an ethics committee or other appropriate institutional resource before entering an order not to attempt resuscitation. (ama-assn.org)
- The absence of an order to resuscitate executed pursuant to s. 401.45 does not preclude a physician from withholding or withdrawing cardiopulmonary resuscitation as otherwise permitted by law. (flsenate.gov)
20212
- Systems Saving Lives' is a new section for Guidelines 2021, although some of the information was part of the 'Education and implementation of resuscitation' guidelines in 2015. (resus.org.uk)
- The process used to produce the Resuscitation Council UK Guidelines 2021 is accredited by the National Institute for Health and Care Excellence (NICE). (resus.org.uk)
Describe3
- Candidly describe the procedures involved in resuscitation, the likelihood of medical benefit in the patient's clinical circumstances, and the likelihood of achieving the patient's desired goals for care or quality of life to address any misconceptions the patient may have about probable outcomes of resuscitation. (ama-assn.org)
- It has been used to describe an absence of utility in resuscitation endeavours but it fails to do this. (bmj.com)
- In this paper we describe a case of prolonged resuscitation with successful outcome. (hindawi.com)
Implementation1
- The department shall adopt rules providing for the implementation of such orders. (flsenate.gov)
Preferences1
- PURPOSE: Code status orders are of high impact and reflect end-of-life (EoL) care preferences. (researchgate.net)
Ethical2
- Because of the wide application of DNR orders, it is important that physicians understand the ethical, legal and medical implications of these documents. (encyclopedia.com)
- This article summarizes the historic background and ethical rationale for DNR orders and describes laws and policies regarding DNR orders in the context of their implications for clinical practice. (encyclopedia.com)
Resuscitate Orders1
- Do-not-resuscitate orders (39%) and written advance directives (34%) were most often studied. (nih.gov)
Shock5
- This study aimed to investigate the effect of mesenteric lymph drainage on the acute kidney injury induced by hemorrhagic shock without resuscitation. (hindawi.com)
- With the development of fluid resuscitation based on microcirculation disturbance theory, the cases of kidney injury induced directly by ischemia following shock decline gradually [ 1 ]. (hindawi.com)
- Our studies showed that the mesenteric lymph duct ligation (MLDL) could alleviate kidney injury following two-hit of hemorrhage and lipopolysaccharide and hemorrhagic shock with fluid resuscitation [ 8 , 9 ]. (hindawi.com)
- However, further studies should be conducted to determine whether or not the blockage of mesenteric lymph return can decrease kidney injury after hemorrhagic shock without resuscitation. (hindawi.com)
- Therefore, the current study investigated the effect of mesenteric lymph drainage on AKI induced by hemorrhagic shock without resuscitation. (hindawi.com)
Patients7
- Do not resuscitate (DNR) orders, along with medical advance directives, are designed to empower patients who are unlikely to derive long-lasting benefits from the use of extraordinary life-saving measures. (encyclopedia.com)
- DNR orders are widely used in the United States , with studies showing that the majority of hospitalized patients who die have had a DNR order written. (encyclopedia.com)
- Under specific circumstances, a large proportion of shocked patients receive delayed fluid resuscitation because factors inducing hemorrhage are complex [ 2 , 3 ]. (hindawi.com)
- In Taiwan, the related issue of not-for-resuscitation (NFR) orders has been debated for at least two decades, especially for patients with life-threatening illnesses. (peerj.com)
- Cardiopulmonary resuscitation (CPR) is a treatment that was developed originally to save the lives of younger people dying unexpectedly from primary cardiac disease 1 and it was never intended to be given to patients who are dying of irreversible underlying disease. (bmj.com)
- Patients should normally have the right to consent to no resuscitation before it is put on a chart. (cbc-network.org)
- It is the first point of contact with the health system for many people, providing timely recognition of time-sensitive conditions, resuscitation and referral for severely ill patients, and the delivery of definitive care for many others. (who.int)
Patient7
- Physicians should address the potential need for resuscitation early in the patient's course of care, while the patient has decision-making capacity, and should encourage the patient to include his or her chosen surrogate in the conversation. (ama-assn.org)
- Ascertain the patient's wishes with respect to resuscitation-directly from the patient when the individual has decision-making capacity, or from the surrogate when the patient lacks capacity. (ama-assn.org)
- It is unlikely that we will ever achieve a consensus definition of futility and certainly not one that is applicable to every patient undergoing resuscitation. (bmj.com)
- How far does a medical team go in order to prolong the life of a terminally ill patient? (encyclopedia.com)
- Like many medical technologies, cardiopulmonary resuscitation (CPR) became the standard of care without careful consideration of its effectiveness in different patient populations. (encyclopedia.com)
- The treating team decided to enter a DNR order, and the patient died shortly thereafter without benefit of cardiopulmonary resuscitation. (the-hospitalist.org)
- This paper describes published accounts of patient, family and caregiver experiences of discussions about advance cardiopulmonary resuscitation (CPR) decision making. (bmj.com)
Medical2
- Do-not-resuscitate (DNR) orders are directives in the medical record that preclude the use of resuscitative measures such as chest compressions, artificial respiration , cardioversion and/or cardioactive medications in the event of cardiopulmonary arrest. (encyclopedia.com)
- The Legislature further recognizes that appropriate emergency services and care often require followup consultation and treatment in order to effectively care for emergency medical conditions. (fl.us)
Survival2
- In these guidelines we emphasise the importance of the connections between the different people involved along the Chain of Survival, and the importance of measuring and improving the performance of resuscitation systems. (resus.org.uk)
- Significant research in cardiac resuscitation has been ongoing since the 1950s, with time, effort and money examining the multiple variables affecting survival rates. (firerescue1.com)
Assessment1
- Instead we should consider the utility of our endeavours, for which an assessment of the harms of resuscitation should be added to our considerations of its benefit. (bmj.com)
Benefit3
- Futility does not consider the harms of resuscitation and we should consider the balance of benefit and harm that results from our resuscitation endeavours. (bmj.com)
- If a resuscitation is futile then any harm that ensues will bring about an unfavourable benefit/harm balance. (bmj.com)
- Several decades of research have shown that, for people who are critically or terminally ill, there is not always substantial recovery or quality of life benefit gained after cardiac cessation and prolonged resuscitation efforts. (encyclopedia.com)
Content1
- The location, storage, and content of resuscitation equipment should be standardized and regularly audited. (vin.com)
Care3
- These instruct the health care team not to use cardiopulmonary resuscitation (CPR) if your breathing or heartbeat stops. (cancer.gov)
- This led to the International Liaison Committee on Resuscitation (ILCOR) Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. (resus.org.uk)
- to highlight the areas for development and discuss the changes that need to be made in order to embed a human rights approach to end of life care. (sueryder.org)
Hospital2
- DNR orders are not exclusive to the in-hospital setting, as some states, for example, Florida and Texas, have also enacted statutes that allow such orders to be valid outside the hospital. (the-hospitalist.org)
- Communication about in hospital resuscitation orders]. (bvsalud.org)
Significant1
- The Clubs were immediately burdened with significant red tape in order to meet the rigorous criteria imposed by UEFA under their Club Licensing Regulations. (chronicle.gi)
Physicians1
- Physicians sometimes extrapolate DNR orders to limit other treatments. (the-hospitalist.org)
People1
- If the director determines that control of an epidemic is necessary to protect the public health, the director by emergency order may prohibit the gathering of people for any purpose and may establish procedures to be followed during the epidemic to insure continuation of essential public health services and enforcement of health laws. (michigan.gov)
Clinical1
- Observations were made of the processes and delays in the clinical setting, from the start of each patient's complaint until discharge, and the receipt and filling of orders for blood at the blood bank. (who.int)
Guidelines2
- There are currently no firm guidelines regarding the duration of such resuscitation [ 2 ]. (hindawi.com)
- MN FACE investigators concluded that, in order to prevent similar occurrences, the following guidelines should be followed: 1. (cdc.gov)
Crucial1
- These orders played a crucial role in slowing the spread in Michigan and have brought new cases down to about 2,500 per day. (michigan.gov)
Cases2
- In some cases, providers and facilities will only proceed with a treatment under a court order. (findlaw.com)
- Since there is no randomized trials that have evaluated the duration of resuscitation and the bulk of information regarding the duration of resuscitation in various conditions such as hypothermia relies on case series and expert opinion, we reviewed all reported cases of prolonged resuscitation in the English literature. (hindawi.com)
Commonly1
- Standardisation is commonly thought of as leading to uniformity and order, while practices are dynamic. (lu.se)
Strategy2
- Northern Ireland's Community Resuscitation Strategy ). (resus.org.uk)
- It is critical that EMS agencies play their part in strengthening this part of the resuscitation strategy in order to improve community health. (firerescue1.com)
Emergency1
- Here are 10 skills you can learn to prepare for an emergency, in no particular order. (cdc.gov)
Study1
- The study inquires into how a specific piece of standardised information, namely the standard for bystander cardiopulmonary resuscitation (CPR), is configured in the practices of lifesaving and bystander CPR-training. (lu.se)
Consent1
- Critics lament that problems - many surrounding the consent issue - continue to plague DNR orders. (the-hospitalist.org)
Manual1
- A blood pressure cuff, stethoscope, cardiopulmonary resuscitation mask, oropharyngeal airways, and a manual resuscitation device are included for use in the event of a cardiac or pulmonary event. (cdc.gov)