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Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques01:30

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Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
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Cardiopulmonary Resuscitation I: Adult01:21

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Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
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Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
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Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
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Operational Amplifiers01:17

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The operational amplifier, often referred to as an op-amp, is a multifaceted building block of a circuit. This electronic component functions like a voltage-controlled voltage source and can also be used to create a voltage- or current-controlled current source. The design of an operational amplifier enables it to execute mathematical operations when external components like resistors and capacitors are linked to its terminals. An op-amp has the capacity to sum signals, amplify a signal,...
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Perioperative Advance Directives: Do Not Resuscitate in the Operating Room.

Michael E Shapiro1, Eric A Singer2

  • 1Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, MSB G-526, Newark, NJ 07103, USA.

The Surgical Clinics of North America
|August 27, 2019
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Summary

Operating on patients with Do Not Resuscitate (DNR) orders requires careful consideration of resuscitation goals. Understanding patient wishes ensures appropriate perioperative care, balancing DNR status with surgical needs.

Keywords:
DNRGoals of carePalliative operationsPerioperative care

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Area of Science:

  • Medical Ethics
  • Surgical Care
  • Anesthesiology

Background:

  • Healthcare professionals often face ethical dilemmas when operating on patients with Do Not Resuscitate (DNR) orders.
  • Existing DNR orders can create confusion regarding intraoperative resuscitation protocols.

Purpose of the Study:

  • To clarify the complexities of managing Do Not Resuscitate (DNR) orders in the perioperative setting.
  • To guide healthcare teams in making informed decisions about suspending DNR orders during surgery.

Main Methods:

  • Review of the origins and implications of Do Not Resuscitate (DNR) decisions.
  • Analysis of special circumstances requiring intraoperative resuscitation.
  • Discussion of criteria for suspending or maintaining DNR orders during the perioperative period.

Main Results:

  • Perioperative resuscitation decisions must align with a patient's overall goals of care.
  • Clear communication regarding patient and family wishes is crucial for ethical decision-making.

Conclusions:

  • Do Not Resuscitate (DNR) orders should be integrated into comprehensive advance care planning discussions.
  • Understanding patient goals of care enhances the appropriate application of perioperative resuscitation strategies.