CPR or not to CPR

Today we discussed some issues of attaining code status.

Thanks to Allen Greenwald to providing us with video footage that the current R2's did for their holiday rounds.

As we mentioned today, this is a tough discussion, and there are many patient and family factors that complicate this.

Key things to express to the family: 

• DNR does NOT mean do not treat
• Goals of care can be readdressed at ANY time
• decisions should be made as per what the PATIENT's wishes are 

In general this is a hard and complicated discussion to have with families who may never had any exposure to this concept. Giving a 'menu' of options is confusion and typically not helpful.

Encourage discussion between family and patients and try to advise what medically makes sense. 

Some interesting articles:

This is an interesting NEJM article on the influence of television code on people's perceptions.

This article shows how our discussions influence the decisions of our patients.

end of life communication

Today we did something a little different for MR and discussed some challenges of determining code status.

Some key tips from todays talk:
-Try to get an idea of goals of care at admission
-Determine if the patient is capable of making own decisions and guide family discussions towards what the patient would like (possible what this patient at their time of health would feel about their current status)
-Be clear that DNR does NOT equal do not treat, but instead means will not try aggressive means of resuscitation when the patients medical state is so far gone that there is little chance of returning to baseline

This is always a tricky conversation and requires practice and honesty.

Here is a A nice NEJM article to read.