Do Not Resuscitate and the need for a central line.

Posted by: admin on: July 27, 2011

  • Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic. The patient is in sepsis and septic shock. Early intravenous antibiotics and aggressive resuscitation is what this patient needs right now. Per the ER report he had already been given three liters of intravenous fluids with the blood pressure barely budging.
  • The patient needs a central venous catheter so that the vasoactive medications (vasopressors) could be given to maintain his blood pressure. The patient was, indeed, DNR (Do Not Resuscitate) which means no aggressive treatment like mechanical ventilation or chest compression in case of a cardiac arrest. So, where do you draw the line between treatment, aggressive treatment and resuscitation?
  • There is no easy answer. It all depends on individual circumstances. Thus, there is a great deal of confusion among the general public and even health care professionals about this.
  • What to do if there is no time to talk, just like in the case above? In these cases we, physicians, often have to make that decision on behalf of the patient. The default tactic in most cases is to do everything you can to stabilize the patient first and then have a discussion with the family or the patient.
  • Not that you have to exclude the family at any point in the patient care process, it’s just that a Code Status discussion is better to have when things are relatively stable.”
  • The bottom line is – there is still plenty of confusion about the resuscitation status among patients and even healthcare professionals. Careful and timely discussion with the patient and the family is, really, the only way those decisions should be made.


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