PDA

View Full Version : Suicide attempts



davo455
01-19-2006, 11:28 PM
Ok bored and starting trouble...How do you feel about suicide attempts with a valid DNR?

NFR22785
01-19-2006, 11:54 PM
Hmmmmmmmmmm...that is a toughie....I would have to check the statutes, but in the case of a valid DNR, if the cause of death is not expected, resucitative measures should be attempted...but I believe the POA could override this....good question.....never been faced with this one before....

DaSharkie
01-20-2006, 06:14 AM
Do Not Resuscitate does not mean do not treat.

NFR22785
01-20-2006, 09:06 AM
Do Not Resuscitate does not mean do not treat.

I agree with you buddy, but you know as well as I do if you bring a patient in to the ED that has a valid DNR and that patient is circling the drain, despite all your efforts, all the staff is going to do is comfort care and let them go peacefully...so we are faced with an uncommon scenario in a very gray area with suicide by a pt was has a valid DNR...personally, I would work the patient, depending on how the suicide was attempted, estimated down time, etc. and let the ED handle it from there just to avoid any legal loop-holes...

mitllesmertz1
01-20-2006, 09:30 AM
Are you serious? DNR, if signed and valid, I won't start CPR, I'll hook up a monitor and confirm (hopefully) end of life rhythm.
If not, we slowly load pt up and slowly take to hospital, where they will hopefully die soon, which is WHAT THEY WANTED IN THE FIRST PLACE!!!!

RoryEl
01-20-2006, 10:16 AM
thats an easy one, suicide attempts invalidate DNR's. Work em

Ridryder911
01-20-2006, 10:27 AM
Don't know how it "invalidates".. a death is a death. The DNR does not state how the death occurs. Remember to have a DNR one usually has to hve a valid medical underlying problem.

I know we sometimes get patients that die from trauma related deaths (fall/ MVC) and we still honor the DNR. So I really do not see, where suicide is excluded, if there was conclussive death. Again, not to say, not to tx. if the patient still has a pulse.

Be safe,
R/R 911

RyanEMVFD
01-20-2006, 02:25 PM
Rory's right, at least in Texas. Suicide attempts, pregnancy and a few other things make DNR's invalid. We work them unless there is something in our protocols that warrants us pronouncing them such as rigor, lividity, decapation, etc.

DaSharkie
01-20-2006, 06:01 PM
No invalidation here either. DNR is DNR and it isn't worked if they are dead.

That being said, if I can treat them with fluid resuscitation, glucagon, or other medications that are not an ACLS medication and are not "Heroic measures" then I will.

CH47Doc
01-22-2006, 01:48 PM
why? if they were DUI and wrecked their car enough to circle the drain and have a DNR would you work em? why? they did it to themselves right? a DNR is a DNR is a DNR...here, the moon, it doesnt matter.

lexfd5
01-22-2006, 08:01 PM
Do Not Resuscitate does not mean do not treat.

I hope some of the newer forum members see this and read it. Just because the CHF patient is having severe DIB and has a valid DNR does not mean you do not aggressively treat the patient.

Weruj1
01-23-2006, 07:57 PM
^^^^^^^^^^^^ this is correct ................I would either work them or if I have a scecond call Med Control.

S8ER95Z
01-23-2006, 08:02 PM
Not a medic..but my take of DNR was 'if they die... do not bring them back'...

if they are hurt/injure/dying doesn't that mean DNR isn't in effect??

mitllesmertz1
01-23-2006, 08:07 PM
While I agree that DNR doesn't mean Do Not Treat, I would disagree with "aggressively" treating them.
The last thing a CHF pt with DNR wants is to end up on a friggin vent for the last month of their life, with a foley catheter, lying in the ICU.
There's no absolute right/wrong answer here, try to get the family involved, and maybe take a minimalist approach as oppsed to an aggressive approach.
If they need aggressive treatment, find out why was 911 called? Did the family panic? Is this part of the normal progression of the disease that caused the DNR to be signed in the first place?
DNR means that the pt has accepted the reality of their impending death, and is trying to come to grips with it.
Sometimes the best thing we can do is allow nature to take it's course while making them comfortable (ie, for the CHF'er, instead of tubing them, maybe some morphine and a little BVM assist?).

DaSharkie
01-23-2006, 08:48 PM
OH don't get me wrong - this is a freaking tightrope to walk, and I probably would not be the most aggressive and would call my MD.

It is just that too many people in most situations do not treat something simple when there is a DNR.

mitllesmertz1
01-23-2006, 11:42 PM
Absolutely Shark, I know what you mean.
Our system approached the Med Director back in 1994-5 and started a trial program that is now the standard.
We looked at situations where the EMT's and medics would withold CPR on a pt for "compelling reasons", ie the pt didn't have a DNR, but in our opinion was in a situation that doing CPR was not what the pt wanted.
The program was met with Overwhelming success.
Everyone was so tired of doing CPR on people that because of a paperwork error (ie DNR not signed, or it's at the son's house), it gave them the opportunity to use some empathy, to respect the family's wishes.
During the trial there were no improper uses of the protocol- we typically did a quiet "is everyone here ok if we don't work this?" amongst the crew.
I was so happy to see this type of policy, it changed us from mindless tards that did CPR on anything that didn't move, to being able to practice a little compassion for the family that didn't wan't grammy violated 10 ways from Sunday.

I hope others can take up the issue with their Med Control.

ALS142
01-24-2006, 01:24 PM
Suicide, no matter how well intentioned, is still a criminal act everywhere in the US, even in Oregon where physician assisted suicide (euthanasia) is legal. The fact that they commited suicide just flat out invalidates the DNR. The DNR is specific to the patient's underlying terminal condition. Now if the patient died because of a MVA or some other accidental reason, the DNR is still valid. The best course of action is to consult with Medical Command and let them make the call.

S8ER95Z
01-24-2006, 05:23 PM
That confuses me...why is it CRIMINAL to kill ones self. I mean why rescue the person who doesn't want to live and then punish them? Never have understood that.

jcfekety
02-09-2006, 01:30 AM
S8 - a few thoughts:

1. Most of our laws come from jolly old England. When the laws were developed the King owned everything and everyone. So, when you stole a chicken you didn't steal Farmer Brown's chicken, you stole the King's chicken. Some of that has carried over. When there is a criminal prosecution it is titled "State vs John Doe" rather than "Victim vs John Doe". So, killing oneself deprived the King of your services, thus being a criminal act.

2. Although I agree with you that it seems silly to throw someone in jail for attempting to commit suicide, our society believes that everyone (unless they have executed a valid DNR) has a desire to live and that if you have a desire to end your life, that desire is the result of a mental illness or defect. Since we protect people with mental disabilities from doing other things to harm themselves - such as giving away all their money to a project to prove the earth is flat - we also protect them from the unnatural desire to end their life. That is why civil mental health commitments are based on whether someone is a danger to himself as well as a danger to others.

RoryEl
02-12-2006, 12:04 PM
Worked in ED yesterday. Pt comes in circling the drain hypotensive, K=8.1, pH= 6.9 NaCHO3- = 1, anion gap = 42, Upper and lower GI bleed, FSBS 43, Loooong QRS, obviously AMS, ARF. family arrives 1 hour behind with medical power of attorney (MPOA). Family member with MPOA states pallitivie care only giving due consideration to prior discussion with pt in ref to her wishes. 2.5 hours later still holding for admission bed, pressure begins dropping and ends up 66/34 - obviously K is back up after initial sequestering intervension wane. MPOA has change of heart and change to full code. Pulls out all stops. This illustratres one of the continuing problems of the emotive lability inherinet in DNR's and MPOA.

In response to why is is a crime to attempt suicide. jcfekety has a good line on the origins of the old english law that underpins our judicial system. Consider this, if it wasn't illegal to attempt suicide, then under what guise would you be able to involuntarily detain the truely suicidal people for mental heath evaluation and treatment?

S8ER95Z
02-14-2006, 12:39 PM
Worked in ED yesterday. Pt comes in circling the drain hypotensive, K=8.1, pH= 6.9 NaCHO3- = 1, anion gap = 42, Upper and lower GI bleed, FSBS 43, Loooong QRS, obviously AMS, ARF. family arrives 1 hour behind with medical power of attorney (MPOA). Family member with MPOA states pallitivie care only giving due consideration to prior discussion with pt in ref to her wishes. 2.5 hours later still holding for admission bed, pressure begins dropping and ends up 66/34 - obviously K is back up after initial sequestering intervension wane. MPOA has change of heart and change to full code. Pulls out all stops. This illustratres one of the continuing problems of the emotive lability inherinet in DNR's and MPOA.

In response to why is is a crime to attempt suicide. jcfekety has a good line on the origins of the old english law that underpins our judicial system. Consider this, if it wasn't illegal to attempt suicide, then under what guise would you be able to involuntarily detain the truely suicidal people for mental heath evaluation and treatment?
Good points / info guys. :)

Of course if it wasn't illegal would could just have a place for them to go take care of themselves with easy cleanup. Probably would illiminate the need to detain and evaluate.