Great job explaining at a level many can understand. From a nurse perspective, it helps to be able to break down what we understand in a way the family/patient can relate to. Thank You!
Great work! My only suggestion on the content is that I would avoid using the term “modified code” as it mixes the intended meaning of code as in code status (dnr vs full code) with care preference such as the use of vasopressor. If a patient does not want vasopressor and you would want to document it, instead of using the term modified code, I would simply write “no vasopressor” to clarify one’s care preference. So much confusion arises from mixing code status with care preference and as a palliative care physician, I try to separate them in my daily practice as frequently as possible so that other providers can learn as well. Thanks
I def want to be helped if BP/blood loss is imminent or very close but don't want to be touched after flat line. I just told a colonoscopy assistant this and she said, "So you mean quality of life". I was like "NO, I mean flat line = flat line and my time is over".
In Canada if you call for a ambulance when someone is having cardiac arrest the patient is given CPR and shock straight away. Oxygen is given to keep brain damage from happening. Only after the patient is stabilized does the Doctor ask if you want DNR if you have another arrest. Most cardiac patients are not able to make a informed decision regarding DNR at that moment.
I gave consent for my loved one last night to shift to DNR yesterday, and this morning discovered that his Tylenol (which was on a schedule) was discontinued for "comfort care". Read that again. He was in pain overnight. I am his activated PoA, and don't understand why I wasn't asked before it was discontinued.
What if corona has over taken your hospital and you ran out of ventilators and someone who's been on a ventilator their heart stops. You have people out there with a better chance to live and they dont have DNR and no time to call family? I am not a doctor. I will never pretend to understand all reasons for things. But if all the person is doing there is waiting for something to remove the virus and get some lung healing which is going to happen any day now. You just to keep them going until then regardless how many people are waiting to be helped. I mean if being busy is one of the deciding factors what about donor status? Some doctors were letting older ones die to save younger coronas. What if the one who's heart has stopped and that corona is a donor? There are 1000s of people dying everyday needing a liver. People dying from the corona. People dying from bad liver. I just totally assumed there was an unwritten code among the hospital that every life has equal value regardless of how overwhelmed the hospital is. you help the sickest person first and that would be the person who's heart has stopped. Unless its a true DNR every life should be given every chance possible. I dont ever want to be a doctor. And I for sure wouldn't want to become desensitized. Maybe that is what happened to sociopaths. They became that way over time do to being over desensitized. New brain pathways have to be forming in situations like that. You slowly start changing who you are as a person. Be careful not to let that ever happen to you. One of society's most valuable citizen. We suck as a country if your ever being made to have to make a choice cuz of lack of equipment. But don't worry our foreign aid to other countries will be on time.
I think it is very important for all medical students to watch videos like this so we are better able to understand all the perplexities that can come with DNR that at their base are simple. There are very strict rules in place for a reason so that even in some of the more complex cases, there is a “blueprint” on what to do in those tough decisions. Some of those could include situations where the patient themselves is not competent to make the choice, in which case a power of attorney would need to have been appointed. This video made me think of a case study I had read once about a family whose father had coded and they were trying to decide to place him on life support or not. The family was not close to their father, and no one had an idea of what his viewpoints about death and a DNR would have been. The family wanted to keep him on life support, but the medical team were unsure if this was the best thing to do when the family had openly admitted they had not had contact with their father in a decade. In those situations, things can get tricky because the patient is not there to advocate for themselves. This is why I think it is always very important to have open communication throughout the entire course of care and upon every PCP visit to really understand the patient’s goals and understand them as a person so that when we run into such issues, there is a more plausible plan of action that one can take.
I have a question- this may be a misconception however how early can DNR be established? Is this only during hospice care or could it be established at a early age because I am 24 and honestly it’s against my religion because I believe that I should die naturally.
I would like DNR but I have the fear the I may be in a lot of pain and they will just let me stay in a lot of pain until I lose consciousness Etc. If I'm headed downhill I definitely do not want to be resuscitated but if I'm borderline, and have a DNR on record, would they keep me comfortable until I go? I'm thinking of a car accident for example and they get to the scene and then find that in my records, then what?
@@susie2251 okay thank you for clarifying. I am just envisioning being in an accident somewhere and what DNR means would they just leave me there or let me bleed out or whatever. And in the hospital I've had so many horrific experiences that I'm wondering if I have a DNR if they'll just let me suffer. I sure as hell have let me suffer on my kidneys failed and after my surgeries.
What do u do if you dont have friends & family listed as Proxy on your Directive? How will I trust hospital.to uphold my DNR w/ no one to enforce. Too many pro lifers out there pushing their agenda!! Thanks for the vid
how come ? like my ex boyfriend never understood why his mother didn't want to bring back to live like sometimes I do but then I really don't like she had cancer and also other things and its sad i just never really like i cant put it right im confused like she was suffering aswell i get that but then like idk man ..........
† Perseverantia † Finalis † I’ve been asked about advance directive but never specifically about DNR. On the other hand, my elderly mother was asked specifically about DNR.
How can I just have to people 2 people who I like to just have them who is speaking for me and my wishes I'm do not want any family of mine having any of them have any say so in my medical care I'm own like the 2 people who are the ones I will have just them to say that it's time to take me off life support
i would choose DNR for me coz I don't want all those central lines, shock, high potent drugs and cpr. i dont even want to be embalmed or cremated when im dead it's so scary and seems painful.
Are there circumstances where a hospital can override a DNR order? Let's say, for example, a patient has attempted suicide. Can that be grounds for a hospital to override a DNR? Just curious.
View the complete course 𝘿𝙉𝙍 𝘾𝙤𝙙𝙚 𝙎𝙩𝙖𝙩𝙪𝙨 free at www.medcram.com/courses/DNR-code
Great job explaining at a level many can understand. From a nurse perspective, it helps to be able to break down what we understand in a way the family/patient can relate to. Thank You!
Quality of Life, NOT number of years!!!!!
Ooh I like your Pillars metaphor on 7:52! I will use that when talking to my patients about it. Thank you so much.
He is an awesome teacher!!!!
Great resource as a pediatric critical care fellow.
Great work! My only suggestion on the content is that I would avoid using the term “modified code” as it mixes the intended meaning of code as in code status (dnr vs full code) with care preference such as the use of vasopressor. If a patient does not want vasopressor and you would want to document it, instead of using the term modified code, I would simply write “no vasopressor” to clarify one’s care preference. So much confusion arises from mixing code status with care preference and as a palliative care physician, I try to separate them in my daily practice as frequently as possible so that other providers can learn as well. Thanks
Thank you for the very clear explanation
I def want to be helped if BP/blood loss is imminent or very close but don't want to be touched after flat line.
I just told a colonoscopy assistant this and she said, "So you mean quality of life". I was like "NO, I mean flat line = flat line and my time is over".
I love this analogy. I'm going to use this with my new nursing students tomorrow when we discuss DNR/Palliative care.
In Canada if you call for a ambulance when someone is having cardiac arrest the patient is given CPR and shock straight away.
Oxygen is given to keep brain damage from happening.
Only after the patient is stabilized does the Doctor ask if you want DNR if you have another arrest.
Most cardiac patients are not able to make a informed decision regarding DNR at that moment.
My husband had cardiac arrest because he was deprived from enough oxygen at Kindred hospital. He had successful CPR and now is doing fine.
Excellent and easy to understand explanation for patients and families!
I gave consent for my loved one last night to shift to DNR yesterday, and this morning discovered that his Tylenol (which was on a schedule) was discontinued for "comfort care". Read that again. He was in pain overnight.
I am his activated PoA, and don't understand why I wasn't asked before it was discontinued.
Thank you for a very clear explanation regarding DNR.
Thank you this is awesome
What if corona has over taken your hospital and you ran out of ventilators and someone who's been on a ventilator their heart stops. You have people out there with a better chance to live and they dont have DNR and no time to call family? I am not a doctor. I will never pretend to understand all reasons for things. But if all the person is doing there is waiting for something to remove the virus and get some lung healing which is going to happen any day now. You just to keep them going until then regardless how many people are waiting to be helped. I mean if being busy is one of the deciding factors what about donor status? Some doctors were letting older ones die to save younger coronas. What if the one who's heart has stopped and that corona is a donor? There are 1000s of people dying everyday needing a liver. People dying from the corona. People dying from bad liver. I just totally assumed there was an unwritten code among the hospital that every life has equal value regardless of how overwhelmed the hospital is. you help the sickest person first and that would be the person who's heart has stopped. Unless its a true DNR every life should be given every chance possible. I dont ever want to be a doctor. And I for sure wouldn't want to become desensitized. Maybe that is what happened to sociopaths. They became that way over time do to being over desensitized. New brain pathways have to be forming in situations like that. You slowly start changing who you are as a person. Be careful not to let that ever happen to you. One of society's most valuable citizen. We suck as a country if your ever being made to have to make a choice cuz of lack of equipment. But don't worry our foreign aid to other countries will be on time.
I think it is very important for all medical students to watch videos like this so we are better able to understand all the perplexities that can come with DNR that at their base are simple. There are very strict rules in place for a reason so that even in some of the more complex cases, there is a “blueprint” on what to do in those tough decisions. Some of those could include situations where the patient themselves is not competent to make the choice, in which case a power of attorney would need to have been appointed. This video made me think of a case study I had read once about a family whose father had coded and they were trying to decide to place him on life support or not. The family was not close to their father, and no one had an idea of what his viewpoints about death and a DNR would have been. The family wanted to keep him on life support, but the medical team were unsure if this was the best thing to do when the family had openly admitted they had not had contact with their father in a decade. In those situations, things can get tricky because the patient is not there to advocate for themselves. This is why I think it is always very important to have open communication throughout the entire course of care and upon every PCP visit to really understand the patient’s goals and understand them as a person so that when we run into such issues, there is a more plausible plan of action that one can take.
I have a question- this may be a misconception however how early can DNR be established? Is this only during hospice care or could it be established at a early age because I am 24 and honestly it’s against my religion because I believe that I should die naturally.
I need a video for parasympathetic and sympathetic nervous system and medications
Thank you thank you thank you
Do I just go to the GP to request this?
Thank you kindly
I would like DNR but I have the fear the I may be in a lot of pain and they will just let me stay in a lot of pain until I lose consciousness Etc. If I'm headed downhill I definitely do not want to be resuscitated but if I'm borderline, and have a DNR on record, would they keep me comfortable until I go? I'm thinking of a car accident for example and they get to the scene and then find that in my records, then what?
I would recommend an advance healthcare directive. That way you can make your wishes more clear.
DNR doesn’t mean no treatment. As he said, the opposite to DNR is palliative care, which is comfort care.
@@susie2251 okay thank you for clarifying. I am just envisioning being in an accident somewhere and what DNR means would they just leave me there or let me bleed out or whatever. And in the hospital I've had so many horrific experiences that I'm wondering if I have a DNR if they'll just let me suffer. I sure as hell have let me suffer on my kidneys failed and after my surgeries.
What do u do if you dont have friends & family listed as Proxy on your Directive? How will I trust hospital.to uphold my DNR w/ no one to enforce. Too many pro lifers out there pushing their agenda!! Thanks for the vid
Great question considering you can't trust them any other time . Thanks
Khan academy has moved on to medical schooling
Thank-x
Take me off DNR, I'm tired of people trying to kill me also please remove donor status OFF my driver's license that may help also
im 26 and want to get a DNR
how come ? like my ex boyfriend never understood why his mother didn't want to bring back to live like sometimes I do but then I really don't like she had cancer and also other things and its sad i just never really like i cant put it right im confused like she was suffering aswell i get that but then like idk man ..........
So? Is this only for people on there way out, or can anyone just get a DNR order?
it wont be advised for a healthy person, but it is your choice.
† Perseverantia † Finalis † I’ve been asked about advance directive but never specifically about DNR. On the other hand, my elderly mother was asked specifically about DNR.
what if there's no family but no CPR is patient requested
Little confused...
So you are saying I have a chance?!
How can I just have to people 2 people who I like to just have them who is speaking for me and my wishes I'm do not want any family of mine having any of them have any say so in my medical care I'm own like the 2 people who are the ones I will have just them to say that it's time to take me off life support
i would choose DNR for me coz I don't want all those central lines, shock, high potent drugs and cpr. i dont even want to be embalmed or cremated when im dead it's so scary and seems painful.
Are there circumstances where a hospital can override a DNR order? Let's say, for example, a patient has attempted suicide. Can that be grounds for a hospital to override a DNR? Just curious.
Broken ribs!