Patient flirting with respiratory failure; what's your treatment?

[VFlutter]

Plus, with a patient that is profoundly hypoxic you can't trust their decision making skills either, while in such a state.

Why are we making this claim off an arbitrary number? This patient is chronically hypoxic because of his disease process and responds differently than you or I would in an acute situation. I have seen these patients drop their sats into the 50s ambulating from the bed to the chair. They are fully alert and aware. This is their every day norm.

Have you considered going to Law school instead of Medical school? In all your posts you seem much more concerned about what a court would think rather than what is best for the patient.

 

[Akulahawk]

What I'm saying is that the law flat out doesn't recognize a verbal DNR. Hence if you rely on a verbal DNR you may as well not have one in the first place. Each state has a particular form and manner that must be used to properly initiate a DNR. If its not done properly, a court of law won't recognize it, simply put. Plus, with a patient that is profoundly hypoxic you can't trust their decision making skills either, while in such a state.

If a patient tells you they don't want to be resuscitated, that's their wishes. Certainly without a properly witnessed form, it's much easier to defend withholding care once a patient meets DNR criteria but when an awake, alert patient states they wish to be DNR and it's witnessed (preferably by LE too), that's almost as easy to defend. To be sure, it's FAR more easy to defend going full-tilt-boogie on such a patient when there's no documentation of the DNR as we can fall back on to "implied consent" because the patient becomes unable to provide consent (or not) at some point.

Your point is that you have a profoundly hypoxic patient whose decision-making skills can't be trusted but if that same DNR patient (who is likely very terminal) says "save me" we assume that the patient suddenly was awake, alert, conscious of events enough to make you disregard the DNR... (Yes, we actually do work those) The point is more of a mental exercise of "why would we trust one statement over another in cases like this?"