DNI

We had a lady in the unit who was loved by her family. They were not quite ready to let her go. In fact, they requested that everything be done for her, except intubation. Unfortunately, she was in respiratory failure. So overnight, her sats began to go from the 90's on a bipap machine to the 80's, then to the 60's and so on. Her fingers were purple, but she had a strong pulse generated by her pacemaker. The daughter was called in because it was obvious that we would have to code this lady. The charge nurse pulled the crash cart into the room and RT was called. Once they had the ambu-bag set up, CPR was started. Drugs were pushed. Her BP came up from the epi push. She had agonal breathing, and unfortunately the efforts to keep her alive without intubation failed. The family came in the room to say their final goodbyes, and she passed on quietly.

I had a hard time understanding why the family wanted CPR but not intubation when the patient was in obvious respiratory failure. I don't know if it was a lack of understanding of the procedures, but generally in this situation, intubation is probably the only thing that would have kept her alive, but she would never have come off of it. Perhaps that is what they were told, and thus the decision not to have intubation. But CPR on a respiratory failure? Did the doctor not fully explain? How come there aren't booklets or pamphlets that will explain this to families and patients, in terms that they can understand? Maybe there are, but I have not seen them. People have spent so much time watching patients miraculously saved on tv shows, and this just isn't reflective of what really happens. When the body is in multi-organ failure, time is minimal and probably not even CPR or intubation will be able to save the person, only prolong the inevitable.

If I were a politically active person, I would be all for pushing for the patient's right to be comfortable in the end. I also believe that if doctors were there on the floors having to care for these patients like nurses do, so many more things would be done to provide comfort measures at the end of life. Especially for DNR patients. I guess I will end my rant here... I understand that ethics is a major player in the above situations for everyone involved. Just sometimes it can be frustrating to watch a person suffer.

-------
On a different note, I get to fully transfer to the ICU as an extern in September. I am so excited!! I have spent the last 6 months out on the med-surg floor, and I am ready for some new areas to explore. I plan on spending the rest of the summer trying to learn the rhythms and ekg's. I have already learned a little bit, but not nearly enough! Though I can pick out a PVC, not that is too difficult really. I just need more experience, plus learning how to recognize the different lead views etc that is shown on the monitor. I am even thinking of purchasing a book to study up on it. It's not that I don't have a ton of things to already finish the rest of the summer. I have to finish my project for the fall. Have a great idea for that. I also need to go down to the school and finish some computer modules that are due this fall as well. Am doing great in my pharm class... our final is coming up soon. Otherwise, have a wonderful rest of July. I am taking a break from blogging unless something fantastic happens in the meantime before school begins.