RAGE Session: Do Not Resuscitate

We’re ready to RAGE again!

This one is 85:26 min long and includes:

• Introduction… kind of (starts 00:00 min)
• ‘What’s bubbling up?’ (starts 02:08 min) — Dr Smith’s ECG blog, DAS Guidelines for tracheal intubation of the critically ill, “The Human Factor” and trauma team performance.
• ‘DNR’ (starts 14:58 min) — the RAGE team discuss the concept of ‘do not resuscitate’ and consensus resuscitation plans, challenges and tips for family discussions and decision-making, and a host of tricky situations (e.g. the family that wants ‘everything’, patients who want to be organ donors, suspension of DNR orders for operations, and patients with advance care plans who attempt suicide)..
• ‘A blast from the past’ by Peter Brindley on ‘Joseph Lister’ (starts 80:44 min)
• ‘Words of Wisdom’ from Karel Habig (starts 83:41 min)

Show notes for this RAGE Session:

Introduction

This RAGE Session features Peter Brindley (@docpgb), Karel Habig (@karelhabig), and Chris Nickson (@precordialthump).

What’s bubbling up?

• Dr. Smith’s ECG Blog
• Higgs A, McGrath B, Goddard C et al. Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia. 2017 (published online)
• Hicks C, Petrosoniak A. The Human Factor: Optimizing Trauma Team Performance in Dynamic Clinical Environments. Emergency medicine clinics of North America. 2018; 36(1):1-17. PMID 29132571

“DNR”

• Burns JP, Truog RD. The DNR Order after 40 Years N Engl J Med. 2016; 375(6):504-506.
• Patients and families that want “everything” done (LITFL CCC)
• Quill TE, Arnold R, Back AL. Discussing treatment preferences with patients who want “everything”. Annals of internal medicine. 151(5):345-9. 2009. PMID  19721022
• Advance Care Planning Australia
• Medical Treatment Planning and Decisions Act 2016 (Victoria, Australia)
• Holt GE, Sarmento B, Kett D, Goodman KW. An Unconscious Patient with a DNR Tattoo N Engl J Med. 2017; 377(22):2192-2193. [article]
• Cooper L, Aronowitz P. DNR tattoos: a cautionary tale. Journal of general internal medicine. 2012; 27(10):1383. [PMC3445694]
• ‘Unacceptable’ that families ‘not told of resuscitation plans’ (BBC, 2016) – base on an RCP audit
• Doctors ‘forced’ to allow suicide (BBC, 2013)
• Geppert C. Saving Life or Respecting Autonomy: The Ethical Dilemma of DNR Orders in Patients Who Attempt Suicide. The Internet Journal of Law, Healthcare and Ethics. 2010; 7(1)
• Henman MP. Suicidal Patients with a Do-Not-Resuscitate Order The Journal of Emergency Medicine. 2017; 52(1):117-120.
• Household words (LITFL CCC)
• Cessation of CPR (LITFL CCC)

Blast from the Past

• Joseph Lister (Wikipedia)
• The Butchering Art by Lindsey Fitzharris review – grisly medicine (The Guardian)

Words of Wisdom

• Spike Milligan’s epitaph ‘I told you I was ill’ voted UK’s favourite (The Telegraph)
• “Two weeks in ICU can save an hour of conversation” — Dr Will Cairns (hat tip to Alex Psirides; @psirides)
• Cairns W. We can improve how we deal with death, now. MJA Insight. [Cited 20 July 2016]