fundamentals
Do Not Resuscitate (DNR) Orders
Introduction
A do-not-resuscitate (DNR) order placed in a person’s medical record by a doctor informs the medical staff that Cardiac Arrest and CPR (CPR) should not be attempted. Because CPR is not attempted, other resuscitative measures that follow it (such as electric shocks to the heart and artificial respirations by insertion of a breathing tube) will also be avoided. This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of life. The success rate of CPR near the end of life is extremely low. (See also As part of care planning for seriously ill people, those people and their doctors should discuss the possibility of Cardiac Arrest and CPR (when the heart stops and breathing ceases) in light of their immediate medical condition, discuss CPR procedures and likely outcomes, and discuss treatment preferences. If a person is incapable of making a decision about CPR, an authorized surrogate may make the decision. A DNR order does not mean "do not treat." Rather, it means only that CPR will not be attempted. Other treatments (for example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided. Depending on the person's condition, these other treatments are usually more likely to be successful than CPR. Treatment that keeps the person free of pain and comfortable (called palliative care) should always be given. All states also provide for special DNR orders that are effective outside of hospitals, wherever the person may be in the community. These are called out-of-hospital DNR orders, Comfort Care orders, No CPR orders, or other terms. Generally, they require the signature of the doctor and patient (or patient’s surrogate), and they provide the patient with a visually distinct quick identification form, bracelet, or necklace that emergency medical services personnel can identify. These orders are especially important for terminally ill people living in the community who want only comfort care and no resuscitation if their heart or breathing stops. Living wills and health care powers of attorney are not generally effective in emergency situations. Additionally, first responders are almost always required to initiate life support unless a valid DNR order is in place and presented to them. Many states are now incorporating DNR status into a portable medical order called Portable Medical Orders . Cardiopulmonary resuscitation (CPR):An action taken to revive a person whose heart stops (cardiac arrest), whose breathing stops (respiratory arrest), or whose heart and breathing stop (cardiopulmonary arrest) Code:The summoning of professionals trained in CPR to revive a person in cardiac, respiratory, or cardiopulmonary arrest No code:An order signed by a person’s doctor stating that CPR should not be attempted (also called a do-not-resuscitate [DNR] order) Irreversible coma:A coma or persistent vegetative state from which the person is not expected to recover Persistent vegetative state:A state in which a person has no awareness but may still have certain characteristics that can simulate awareness, such as opening their eyes, having normal sleeping and waking periods, sucking, chewing, coughing, gagging, and swallowing Terminally ill:The medical state of being near death where there is no possibility of cure Life-sustaining treatment:Any medical procedure, medication, or technology that can keep a person alive for a period of time but that cannot cure a terminal condition Hospice Care : 