DNR Should Be The Default - PRO: Alex Psirides, CON: Sara Gray

BARE KNUCKLE ICU

DNRSHOULD BE

THE DEFAULT

@psirides

Wed June 15th

“ 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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PR

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.

Public Perception of CPR

100 in-patients aged ≥70 years were asked “if you had a cardiac arrest, what would happen?”

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81% believed they had ≥50% chance of leaving hospital with no disability

23% believed the chance of no disabilitywas ≥90%

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

ON TV, NO-ONE ARRESTS FROM‘OLD AGE’

NEJM 1996

PRESIDENT TRUMP

Doctors Die Differently

100% of doctors are trained to perform a procedure

BY DEFAULT that 90% of them wouldn’t want themselves

OHCA=IHCA

How People Die

Murray et al, BMJ 2008

of IHCA arrhythmias are non-shockable72%

Assess Rhythm

Non-Shockable

CPR For 2 Minutes

REPEAT

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2014

38,092 patients who received CPR

whilst an

in-patient

49 DEAD

DURING CPR

34 DEAD BEFORE

DISCHARGE7 DEAD BY

1 YEAR10 ‘ALIVE’

“I want to die peacefully in my sleep like my father, not

screaming & yelling like the passengers on his bus.”

Steven Wright

NO IN-PATIENT SHOULD EVER RECEIVE CPR

2 weeks in ICU can save you 1 hour of

difficult conversation

Dr.Will Cairns

DNRSHOULD BE

THE DEFAULT

POOR COMMUNICATION CAUSES HARMFr

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via

YouT

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@psirideswellingtonicu.com

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DNR should not be the default

Sara Gray

56%

DNR should not be the default

Age 70?

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@EmICUcanada