DNR Should Be The Default - PRO: Alex Psirides, CON: Sara Gray
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Transcript of DNR Should Be The Default - PRO: Alex Psirides, CON: Sara Gray
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BARE KNUCKLE ICU
DNRSHOULD BE
THE DEFAULT
@psirides
Wed June 15th
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“ First I will define what I conceive medicine to be. In general terms, it is to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their disease, realising that in such cases medicine is powerless.
#Hippocrat400 BC
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Vide
o fro
m T
he W
ellc
ome
Libr
ary
A B
rie
f H
isto
ry o
f C
PR
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A Brief History of CPR
5 Cases
35yr old under GA9yr old post GA
80yr old under GA12yr old under GA
45yr old in ED
1960And no brain.
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Public Perception of CPR
100 in-patients aged ≥70 years were asked “if you had a cardiac arrest, what would happen?”
‘Mis
conc
eptio
ns A
mon
g El
derly
Pa
tient
s’, A
dam
s et
al 2
006
81% believed they had ≥50% chance of leaving hospital with no disability
23% believed the chance of no disabilitywas ≥90%
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TV Shows CountryNo. Episodes
Screened
No. Cardiac Arrests
WitnessedOutcome
Casualty,Cardiac Arrest,
MedicsUK 64 52* 25% survival
Grey’s Anatomy, House US 91 46
69.6% ROSC,71.9% survival to hospital discharge
ER,Chicago Hope,
Rescue 911US 97 60
75% ROSC,67% survival to hospital discharge
Star Trek: TNG, DS9 & Voyager
Outer Space 526 96 13% ROSC,
9% long-term survival*48% of patients <35 years old
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ON TV, NO-ONE ARRESTS FROM‘OLD AGE’
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NEJM 1996
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PRESIDENT TRUMP
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Doctors Die Differently
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100% of doctors are trained to perform a procedure
BY DEFAULT that 90% of them wouldn’t want themselves
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OHCA=IHCA
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How People Die
Murray et al, BMJ 2008
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of IHCA arrhythmias are non-shockable72%
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Assess Rhythm
Non-Shockable
CPR For 2 Minutes
REPEAT
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Ebel
l et a
l, Cr
itical
Car
e M
edic
ine
2014
38,092 patients who received CPR
whilst an
in-patient
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49 DEAD
DURING CPR
34 DEAD BEFORE
DISCHARGE7 DEAD BY
1 YEAR10 ‘ALIVE’
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“I want to die peacefully in my sleep like my father, not
screaming & yelling like the passengers on his bus.”
Steven Wright
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NO IN-PATIENT SHOULD EVER RECEIVE CPR
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2 weeks in ICU can save you 1 hour of
difficult conversation
Dr.Will Cairns
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DNRSHOULD BE
THE DEFAULT
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POOR COMMUNICATION CAUSES HARMFr
om C
runc
hGam
er1
via
YouT
ube
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@psirideswellingtonicu.com
All i
cons
take
n fro
m T
he N
oun
Proj
ect
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DNR should not be the default
Sara Gray
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56%
DNR should not be the default
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Age 70?
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