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Thursday, January 7, 2010

DNR's

We were toned out for a person having trouble breathing. When we arrived at the apartment I walked in the door and was immediately aware of the little tiny dog, on a chair next to a hospital bed (in the living room) trying to attack me. The dog jumped off the chair at me but was deflected by the 19 year old son of my patient. The dog then tried to go around the chair and attack my ankles. This time he was foiled by my 20 lb. orange drug box (it's orange so we don't forget it at someones house...from time to time we still do). After the kid grabbed the dog I noticed that my patient was slumped over with her head dangling off the far side of the bed. My patient was a woman in her early fifties that must have weighed about 100 pounds and had the look of someone that had been withered away by cancer. I quickly pulled her up to a normal position on the bed and checked to see if she was breathing. She wasn't.My engineer and I immediately grabbed her and drug her to the floor where we could work. While we were doing this my captain checked with the son about a DNR. I repositioned her airway and rechecked her breathing and I this time I also checked for a pulse. While my engineer got the BVM and oxygen out I found my landmarks to do chest compressions. Just as I was about to start my captain said that my patient had a valid DNR



At this point I placed the patient on the heart monitor to ensure that there was no electrical activity. She was in asystole in all leads. We then carefully placed the deceased back into bed and cancelled the other responding units.



According to the son my patient had been fighting cancer for several years. It had recently metastasised and his mother's health had started really deteriorating. He had gone to work just down the street despite the feeling that he should have stayed home. During his lunch break he decided to come home and check on his mother and that's when he found her slumped over in bed.

The nice thing about the DNR is it allows the patient to determine what they want done to them in just this scenario. For those of us in the EMS field we generally don't want to go through what we do for someone in full arrest. We'd rather be let go. We often joke about wearing a t-shirt or getting a tattoo of a DNR. We are a sick and twisted bunch I know.

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