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DNR or POLST end of life decisions

minkeygirl

But I Look So Good.
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4,678
Location
Left Coast
I've had the pink POLST (physician order of life sustaining treatment) form sitting on my coffee table. I always thought I do not want to be resuscitated because i don't want to end up worse. I brought this up a few months ago on a different thread. Still haven't made a decision.

I was searching around today and found this interesting interview about how these forms are misunderstood.

http://www.medscape.com/viewarticle/842419
 
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minkeygirl

But I Look So Good.
Messages
4,678
Location
Left Coast
@AaroninOregon It's an interesting article. I was looking at my POLST form today and you're stuck with 2 options. Don't shock or do and if they do, they do a bunch of other stuff.

Like the article says there should be more choices, more clarity. For me there is a huge difference being shocked after I had a heart attack vs. some other reason. If I had a heart attack, I don't know if I would want to be brought back, I'm sure my life would be much worse. But if some other thing? And I'd be back where I am? maybe? I really don't know.

I've always told the person who has the authority to "pull the plug" no heroic measures. For some reason a DNR is different in my mind.
 
Messages
170
Location
Hippietown
@AaroninOregon It's an interesting article. I was looking at my POLST form today and you're stuck with 2 options. Don't shock or do and if they do, they do a bunch of other stuff.

Like the article says there should be more choices, more clarity. For me there is a huge difference being shocked after I had a heart attack vs. some other reason. If I had a heart attack, I don't know if I would want to be brought back, I'm sure my life would be much worse. But if some other thing? And I'd be back where I am? maybe? I really don't know.

I've always told the person who has the authority to "pull the plug" no heroic measures. For some reason a DNR is different in my mind.


yeah depending on why your heart needed to be shocked one might be coming back to a much worse place than they started. Definitely something to consider. There needs to be a "customize-able" form with room to add more specific instructions.
 

barbc56

Senior Member
Messages
3,657
I have a question as I won't be able to read the artical tonight. I also want to read @minkeygirl's other thread as this is an important issue.

What are you suppose to do with the form? Should you send it to family members? I know it would go in my chart but if I'm away from home or other family members not around? Facebook?:rolleyes:

I have so many of these forms and keep forgetting to fill it out. Sigh.

I would think that the protocols for these things differ by country.

Thanks for posting this. I will read the article/thread tomorrow so if the question is answered there I will hopefully see it. But just in case....

Thanks
Barb
 

minkeygirl

But I Look So Good.
Messages
4,678
Location
Left Coast
@barbc56 The form must be signed by your doctor. One copy is kept in your permanent file. I would also tell whoever is your power of attorney for healthcare. Make sure that is up to date. I was looking at mine which is how I got on this today.

I was told by a social worker to keep it posted where it can be seen when someone walks in the door. Or in my purse. The POLST is Hot pink so there is no missing it.

There are also bracelets you can get. Something to keep on you that says DNR.

http://www.polst.org/about-the-national-polst-paradigm/what-is-polst/

http://www.polst.org/wp-content/uploads/2013/02/Clin08-01.pdf

http://www.emsa.ca.gov/Forms

@AaroninOregon Yes I think the point of the article is to show it's not very "forgiving". The problem is when someone finds you on the floor, they aren't going to know if you had a heart attack or not. My fondest wish is to die like my dad. In his recliner watching the football game. or waking up dead. I'm good with either.

When I googled DNR, I got a state form and a place to contact. So you can probably find it by state or country.

I wonder what @heapsreal has to say about this.
 
Messages
170
Location
Hippietown
@AaroninOregon Yes I think the point of the article is to show it's not very "forgiving". The problem is when someone finds you on the floor, they aren't going to know if you had a heart attack or not. My fondest wish is to die like my dad. In his recliner watching the football game. or waking up dead. I'm good with either.

When I googled DNR, I got a state form and a place to contact. So you can probably find it by state or country.

I wonder what @heapsreal has to say about this.

That sounds like a good way to go as I do love watching football. I don't have a recliner, but passing while lying on the couch watching football works.
 

heapsreal

iherb 10% discount code OPA989,
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10,076
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australia (brisbane)
@heapsreal as a first responder, how do you handle if when people need resuscitation?

Do you have Do not resuscitate forms there? What is the protocol there?


Yes. Generally patients are in nursing homes. If they are really sick and in a nursing home we generally ask them if they have a DNR. We really need to see the document and cant go by what nursing staff say or relatives.

someone mentioned a dnr bracelet, but honestly before we noticed it, we would probably have started cpr as its a priority not really looking for bracelets. To be honest im not sure a bracelet would be enough, i have never seen a dnr bracelet. Heard a few paramedic mention getting a tattoo across their chest with dnr, but were sort of half joking.
 

Gingergrrl

Senior Member
Messages
16,171
someone mentioned a dnr bracelet, but honestly before we noticed it, we would probably have started cpr as its a priority not really looking for bracelets.

@heapsreal I was just curious from your statement if paramedics or the ER ever look for Medic Alert bracelets or if these are not really that useful? I know it may vary in different countries or states but your comment made me think. Do they read them if people have allergies or an emergency contact on it, etc?
 

heapsreal

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10,076
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@heapsreal I was just curious from your statement if paramedics or the ER ever look for Medic Alert bracelets or if these are not really that useful? I know it may vary in different countries or states but your comment made me think. Do they read them if people have allergies or an emergency contact on it, etc?


In a cardiac arrest theres other priorities . But if someone was unconscious and we didnt no why then we go searching and more detailed examination , so should find it.

the allergy alerts bracelets and diabetic alerts help. Although these days with diabetics, a blood sugar is tested on most patients so wo I ld be picked up.

also adrenal crisis/addisons are somewhat common and generally carry their own hydrocortisone ? ?

another good thing to note is paramedics like it when u keep a list of conditions medications and allergies written down. Have one in the handbag/wallet and beside the bed . Makes things alot easier.

So depends on the situation.
hope that helps.
 

heapsreal

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Ps keeping copies of dnr's handy would also be beneficial and ones drs details too. If ones gp has knowledge of the patients terminal condition, they can give directions to cease resuscitation efforts also, thats if they are willing to write a death certificate also??
 

Gingergrrl

Senior Member
Messages
16,171
Thanks @heapsreal and that is really helpful.

I know we are in different countries but in general as a paramedic if you or your colleagues had a patient with a bracelet that said anything re: mast cell disease- MCAS, MCAD, mastocytosis, etc, would the paramedic or hospital know what that means or how to find the TMS Emergency Room protocols for which meds are safe vs. life threatening?

Am just curious as I am wanting to get a bracelet and deciding on the best wording (plus the wallet card and other stuff you mentioned.)
 

heapsreal

iherb 10% discount code OPA989,
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10,076
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australia (brisbane)
This is just my opinion but, if one has a cardiac arrest , unless witnessed and cpr done straight away and a pulse returned within approx 20mins.If a pulse returns outside of that, generally the outcome isnt good.

Exceptions are healthy people who cardiac arrest from non cardiac events eg from drownings, overdoses, asthma etc. But odds still arent great.

hope im not being too down and gloomy.
 

heapsreal

iherb 10% discount code OPA989,
Messages
10,076
Location
australia (brisbane)
Thanks @heapsreal and that is really helpful.

I know we are in different countries but in general as a paramedic if you or your colleagues had a patient with a bracelet that said anything re: mast cell disease- MCAS, MCAD, mastocytosis, etc, would the paramedic or hospital know what that means or how to find the TMS Emergency Room protocols for which meds are safe vs. life threatening?

Am just curious as I am wanting to get a bracelet and deciding on the best wording (plus the wallet card and other stuff you mentioned.)


Omg i dont really understand it myself.

Most emergency resuscitation drugs dont have alot of contraindications. But once stabilized in the ER drs are commonly looking things up online or ringing specialists for advice. So identification of particular disorders would be helpful .

That make sense ?
 
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2,562
Location
US
Receiving CPR is scary to me. They supposedly always crack or break ribs, unless the CPR is done wrong. And broken ribs are supposed to be extremely painful.
 

heapsreal

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10,076
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Receiving CPR is scary to me. They supposedly always crack or break ribs, unless the CPR is done wrong. And broken ribs are supposed to be extremely painful.

Yes mostly ribs are broken but depends on age etc.
if you survived cpr etc you would be in intensive care for awhile and be on some good pain killers.
if they cant get an IV in, they drill into your leg or shoulder to obtain access to your circulation , intraosseous needle. Sounds worse than it looks but ouch . Watching a catheter go in makes my eyes water more ew ouch.