I don't know if those initials are the same everywhere, but if they are not, I'll spell it out. DO NOT RESUSITATE - Comfort Care Only. Pretty self explanatory correct?

I have a scenario. A 90 year old woman who is alert and oriented x 3, showing no signs of dementia or alzheimers. She has never expressed suicidal ideations with a plan before, but has mentioned that she is the last of the remaining people she knows and that death would not be an unwelcome stranger. She's pleasant most of the time and she resides in a nursing home.

While in the nursing home, she gets ahold of straight edge razor and slices her throat, her wrists, her inner elbows, her wrists and and the back of her knees. Some of her wounds are superficial and some of her wounds are deep and penetrating to the deep fatty tisuue requiring sutures.

She is found by the nursing staff covered in blood and is immediately sent to the ER for treatment.

Here is my question. If she has signed her DNR-CC papers, she's altert and oriented x3, and has had no previous suicidal attempts or psychiatric history. What is the ruling on the DNR-CC status?

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www.MyOwnWoman.blogspot.com

MOW,

Perhaps I do not understand your question as you intended it to be understood. If so, please overlook what I am about to write.

DNR - with or without the 'CC' - does not mean "Do not Treat." It simply means that no attempt to resuscitate is to occur when the heart quits beating. Since the woman you described still had a pulse when found, the caregivers had every legal right to summon assistance. The woman's DNR status remains legal and binding no matter her attempt to suicide.

The next time - and surely there will be a next time unless the woman can find something to live for - the next time the woman may be successful in killing herself. I hope she is offered treatment for her supposed depression. And I hope that, should she be determined to commit suicide, she choose a manner of death that is rapidly effective and that does not traumatize her caregivers.

Am I missing the mark here?

Joy

Ditto to what Joy said. DNR does not mean Do Not Treat!

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code blog

I also believe that we must treat things as they come up, but according to the patient's wishes. Death and dying issues can get sticky when someone is on their deathbed, and I really wish everyone had a living will. Attempted suicide, however, is a whole different ball game. Depression is treatable and the woman needs help.

MJ

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Sanity is madness put to good use. George Santayana.

http://nurse-ratcheds.blogspot.com

I'm in the same ballpark with everyone else -

This patient did not need resuscitation. She was still beating and breathing - she needed treatment for self-inflicted lacerations and suicidal behavior.

Now, if they had found her without a pulse or breathing, she would have been in an arrest and the DNR would have been in effect.

To me resuscitation means actions to re-start a heart or breathe for someone when they stop. If they are doing those things on their own, they don't need resuscitation and the DNR does not apply.

And I agree with MJ, depression is a biggie here and often undiagnosed in the elderly.

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The ER is the only place where you are rewarded for efficiency by getting more patients!

Kim
http://www.emergiblog.com

I totally agree with everyone here. She may have a DNR-cc but hey, the way I see it, stitches in her lacerations is comfort care... A DNR is not a "Let Me Bleed To Death From Self Inflicted Wounds Or Die Of Sepsis From Untreated Lacerations" form. Nor is it a "Just Say Screw It And Let Them Die" form.

Stitches, from my inexperienced and unschooled opinion, are not "resuscitation" so.. yeah.

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"Great spirits have alwasy found violent opposition from mediocrities. The latter cannot understand when a man does not thoughtlessly submit to hereditary prejudices, but honestly and courageously uses his intelligence." -Albert Einstein

My blog!

We have NFR (not for resus), we also have MET calls (medical emergency team).

It is not resuscitation to stop bleeding and sew her up again. However she will now have a history of self harm and could now be determined to be high care.

There a levels of resus and they should be document as to how far the team is to go. Intibate without defib, or no intibation; as example.

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'Think not of yourself as the architect of your career but as the sculptor. Expect to have to do a lot of hard hammering and chiselingand scraping and polishing. - BC Forbes'

Do you mean Intubate P/J?

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Julie
http://www.lifeinthenhs.wordpress.com

Ha Ha, so I wrote it in a hurry We all know what I meant

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'Think not of yourself as the architect of your career but as the sculptor. Expect to have to do a lot of hard hammering and chiselingand scraping and polishing. - BC Forbes'