Do Not Resuscitate: Understanding DNR Orders

A DNR or Do Not Resuscitate Order is a set of written instructions from the patient’s healthcare partner or physician telling healthcare professionals not to perform CPR or Cardiopulmonary Resuscitation (CPR) on the patient if and when an emergency arises.

Do Not Resuscitate

A DNR or Do Not Resuscitate Order is a set of written instructions from the patient’s healthcare partner. Or it is a physician telling healthcare professionals not to perform CPR or Cardiopulmonary Resuscitation (CPR) on the patient if and when an emergency arises. It is common practice for healthcare professionals to perform CPR on patients during an emergency unless they have a Do Not Resuscitate or DNR order. A lot of factors should be considered before a patient can request for a DNR order from his/her health partner or physician. In this article, we will look at what Cardiopulmonary Resuscitation or CPR is. We will understand why it is beneficial, and why some patients would rather not have the said procedure applied to them during an emergency situation through a Do Not Resuscitate or DNR order.

What is Cardiopulmonary Resuscitation or CPR?

The Cardiopulmonary Resuscitation or CPR is a technique used to save patients’ lives during emergencies. These emergencies usually cover cases where the patient’s heart stops breathing such as during a heart attack or drowning. People attempting to conduct Cardiopulmonary Resuscitation or CPR must keep in mind that it may not always be successful. However, bystanders and even those untrained in doing the said life-saving technique of CPR must at least try to do the aforementioned technique during specific medical emergencies as doing something is always better than doing nothing.

How is the Cardiopulmonary Resuscitation (CPR) performed?

The Cardiopulmonary Resuscitation or CPR can be performed or accomplished using the initials C-A-B or Compression, Airways and Breathing. Before going through all the steps, the individual wanting to perform CPR should ensure that basic factors of safety are considered. These include checking if the area where the CPR will be conducted is safe. They should also check if the person is either conscious or unconscious and check if there are other people that can make that all important 911 call.

Compression

The first letter in C-A-B stands for compression. This step is very important as compression helps restore the downed patient’s blood circulation. To do this, the individual performing the Cardiopulmonary Resuscitation or CPR must ensure that the patient is lying flat on his/her back, the person should then kneel beside the lying patient and place the heel of his/her palm in the middle of the patient’s chest with his/her other hand placed right behind it, then using his/her body weight, the individual should press down on the patient’s chest ensuring chest depression of no more than two (2) inches.

Airways

Next in the abbreviation C-A-B for Cardiopulmonary Resuscitation or CPR is the letter “A” which stands for Airways. Opening the airways for the patient undergoing Cardiopulmonary Resuscitation or CPR will greatly help in restoring vital body functions and may even help in making the patient conscious. Opening the airways can be done by tilting the patient’s head back and lifting his/her chin.

Breathing

Finally, the person administering the Cardiopulmonary Resuscitation or CPR must conduct the last letter of the C-A-B abbreviation which is the letter “B” or Breathing for the patient. This kind of rescue breathing can be done mouth to mouth or mouth to nostrils depending on the condition of the patient’s mouth.

The person administering Cardiopulmonary Resuscitation or CPR must first pinch the nostrils of the patient shut for breathing into his/her mouth, giving two (2) rescue breaths and checking for the patient’s chest to rise with the cycle of thirty (30) chest compressions and two (2) rescue breaths considered as being one (1) complete cycle. These cycles of the Cardiopulmonary Resuscitation or CPR must be continued until the patient shows signs of movement or until such time that medical personnel arrives to aid the patient.

Why would patients not want Cardiopulmonary Resuscitation or CPR conducted on them during medical emergencies?

As detailed above, patients with a heart attack or drowning related emergency can provide a life-saving way out from the said emergencies. However, there are some cases where Patients may opt not to have the Cardiopulmonary Resuscitation or CPR technique applied to them thereby issuing a Do Not Resuscitate (DNR) order. A patient may not want Cardiopulmonary Resuscitation or CPR conducted due to the following reasons:

The administration of the Cardiopulmonary Resuscitation or CPR will no longer provide the expected benefit

The Cardiopulmonary Resuscitation or CPR may no longer be beneficial to the patient thereby resulting in the patient issuing a Do Not Resuscitate (DNR) order. This could be due to a number of medical conditions such as those patients with severe health problems and those patients with terminal illness.

The conduct of the Cardiopulmonary Resuscitation or CPR may result in life-limiting consequences and reduced quality of life for the patient 

The results of the Cardiopulmonary Resuscitation or CPR may not always lead to ideal conditions for the patient. Significant brain or internal organ damage may have already occurred even after the conduct of CPR. This can especially be true for elderly patients and individuals who are immunocompromised or frail.

The administration of the Cardiopulmonary Resuscitation or CPR may interfere with the results of a terminal illness which is a peaceful death 

Some patients with a terminal illness or life-ending disease may prefer to have a peaceful death instead and may choose not to have Cardiopulmonary Resuscitation or CPR perform and issue a Do Not Resuscitate or (DNR) order.

The abovementioned factors are all taken into consideration by the patient’s doctor or physician along with the beliefs and personal preferences of the patient. With that being said, it is important to note that Do Not Resuscitate or DNR orders will also be considered alongside the following factors:

Other Medical Treatments

Patients should be made aware that issuing a DNR order does not equate to receiving any other medical treatments at all. Other medical procedures may still be performed on the patient.

Applicability of the Do Not Resuscitate or DNR Order

The DNR Order may apply to the hospital but may not have any authority for implementation within the community. A separate authorization or Order from the Department of Public health or other government health agencies must be secured to ensure community applicability of the DNR Order.

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