oddissy4u
Forum Guru
Topics: 107
Posts: 389
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Mr. S is a 73-year-old man, with a history of severe coronary artery disease, peripheral vascular disease, and stroke. He suffers from right hemiplegia and mild expressive aphasia. He is awake and alert, and presents for right below the knee amputation (BKA) for vascular insufficiency. His chart carries a DNR order. In the holding area prior to surgery, the anesthesiologist discusses the DNR order with Mr. S, who appears depressed. Mr. S states unequivocally, that he does not wish CPR in the OR, regardless of its cause or positive prognosis. He tells his anesthesiologist that he is willing to go "so far, and no more." The patient agrees to subarachnoid anesthesia (spinal block) and sedation. He is not intubated. After about 20 minutes, the patient complains of weakness in his arms, and difficulty breathing. Within 3 minutes, his blood pressure and heart rate fall, and he abruptly arrests.
Should the patient be intubated? Should CPR be commenced?
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| Ouli Maty
Forum Elite
Topics: 33
Posts: 275
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I would say intubate him and do the CPR. Those two actions are part of the surgical procedure. I mean if you want to go with regional anesthesia, you should always be aware of the possibility of complication that would lead you to a general anesthesia and intubation. And the patient should be aware of that.
The DNR should be apply for terminal cases but not for an amputation from which the patient expect to recover despite the severity of his others symptoms. :!:
Do we have to consider the DNR order anyway after knowing that he is depressed :?:
___________________
deep breathing...
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