ICD&Advanced Medical Directive

Here is an interesting one:
What are the implications of having an Advance Medical Directive that specifies Do Not Resuscitate (DNR) and having an ICD that does exactly that. I realize that the the defibrillator used my EMT's is more powerful and therefore different than the ICD. I'm thinking more about intent. Could medical facility conclude that since the person consented to the ICD that there is a question about their intent and decide it was better to resuscitate and ask questions later?
Might be worth considering and using clarifying language in the Advance Medical Directive. I don't have an ICD so it isn't an issue with me.

frank

7 Comments

Hi Frank

by Peter.Nash - 2008-03-15 02:03:56

If the The jigger they use to resuscitate you in hospital is more powerful than My ICD I think it is better not to go there I think it would fry my ticker...the first time my ICD fired it nearly blew me to "Kingdom Come"

But a good question. here in the uk you can have this DNR put in your notes at the hospital whether that would stop them zapping you I don't know I guess it depends on who reads what at the time. If they do read it you will never know if they dont you might get a bonus....
Peter N

DNR

by elleinad23 - 2008-03-15 09:03:48

As a paramedic I can tell you that we will honor your DNR wishes as long as you have the proper paperwork which you can get from a dr or hospital. It makes no difference if you have an ICD or not. If there is no paperwork presented immediately, we resuscitate. "When in Doubt, Resuscitate!"

I also agree with the paramedic that you had talked to Karen. I too do not wish to be resuscitated. Now I don't have a DNR, but have told my family of my wishes. I have thought about getting one but might not be alive today if I had one. Main thing for me is that I don't want to be a vegetable forever! Sometimes people might just need a tube to breath for a day or two and get better and with a DNR you would never get that opportunity. If they told my family I was never going to get better than they are instructed to have them pull the plug! Just thought I'd share my perspective on the issue.

Danielle

DNR for me!

by auntiesamm - 2008-03-16 01:03:11

Hi Friends,

From my perspective as a hospital "insider" I most certainly do not want to be resuscitated under any circumstances. I've told my family this many times! I have threatened to have DNR tatooed across my chest. Unfortunately, medical records in the hospital get shuffled (still aren't paperless) pages fall out of the medical chart, someone FORGETS to write it down, nothing noted on the very front of the chart and so on. When a code is called in the hospital and the team responds they seldom know whether the patient is a DNR so will do full-blown resuscitation. Years ago I witnessed this situation: older male patient on acute inpatient rehab unit with quadriplegia - a moped injury. No brain injury and he was very clear about his wishes of no CPR. As luck would have it he "coded"; one of the physicians standing outside patient's door was the first responder and started CPR before the Code Blue team arrived. He did not know the patient nor of the DNR. Once a code is started it cannot be stopped just because someone remembered patient was DNR. This has happened countless times; I just happened to be a direct witness to this situation. Needless to say, the patient and his wife were extremely upset! He did poorly and ended up in a nursing home where he died not long after that. Sorry for the lengthy post but this is a very important issue and we all need to be aware of how things can occur even if we have covered all bases. I hope this gives everyone a little "food" for thought. I've also been told that if my heart really goes into a tailspin of somekind, or if I have other major organ failure my PM will not prevent my death. I send good wishes and God's blessings to all.

Sharon

DNR

by ElectricFrank - 2008-03-16 01:03:28

My experience fits what you say Daniel. When I found my wife obviously dead I called the coroners office first and since I am in small town they were at my door in minutes. I showed them my wifes DNR and there was no problem. they did call for the EMT's to stop by and confirm her death with an ecg, but let me know that this wasn't going to lead to resuscitation.
By the way my wife and I had/have an exception that if it is obvious that cardiac arrest has been for a very short time (I can't remember how we stated it) then an attempt at defib is acceptable. It also stated that if one of us is present then that persons decision will be final. The coroner's people were impressed with it.
My concern with the original post is about encountering a situation where some "right to life" type decides to find a reason to go against our wishes. In that case the situation I mentioned of an ICD showing a conflicting desire could happen. If I had an ICD I think I would amend my DNR to cover that issue.

frank

DNR Suggestions

by ElectricFrank - 2008-03-16 04:03:17

Sharon,
This is all too common. I hadn't thought about a tatoo!! Good one. Maybe tatoo "Warning, Bomb inside".

I understand that AARP has a DNR card that you can carry in your wallet. I keep one on a table in the entry to our home. I also have one in a prominently labeled envelope in the glove compartment of both cars.

The interesting thing about all this is that won't let us die and yet they make all sorts of mistakes when we would rather live. I have a good friend who's wife died waiting for angioplasty in a well know heart hospital in Los Angeles. She was left in the hall outside waiting to go into O.R. and went into arrest. She wasn't noticed for 15 minutes. Her husband who is a biomedical engineer was admitted for the same problem and after surgery was left in his hospital room with no one checking on him for over an hour after the surgery. He decided to try pulling on of the monitoring electrode leads loose to see what would happen. It was another 15 minutes with the monitor squealing before a cleaning women came in.

So if we want to live they let us die..if we want to die they make sure we live.

frank

Signed DNR

by auntiesamm - 2008-03-16 08:03:22


My husband was critically ill last August/September. We called paramedics 3 times. The home health nurse and the 'medics all told me the first place they will look for a DNR/Advance Directive is on the front of the refrigerator. This is apparently standard, accepted procedure in So California. Makes sense though, so that is what we have done. Thank the good Lord we haven't had to use it!

Sharon

Thanks for the suggestion

by ElectricFrank - 2008-03-17 04:03:39

Great input Sharon. I'll put a copy there.

Maybe I could put a note to help yourself to a snack while I die!!!

I hope this is taken as a joke!

Glad to hear your husband made it. I hope he is doing OK.

frank

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