A 74 year old lady patient of an elderly local doctor is on the telemetry unit.   You are called to the bedside to assess her for an SVT that has not stopped for the last 15 minutes. The nurse points out that the patient is a DNR. What should you do?

  1. Institute comfort measures
  2. Start her on a Cardizem drip and transfer her to ICU - like you would for someone who is not on DNR status
  3. Start her on a Cardizem drip and NOT transfer her to ICU - because she is on DNR status
  4. Insert an endotracheal tube
  5. All of the above are reasonable options


DNR ¹ DNRx

DNR holds a meaning only in the code situation. When a patient has either cardiac or respiratory ARREST, we will not start CPR. That is what it means. It does not hold you back from a treatment that addresses a different issue. For example, if a patient who is DNR goes into VT where he has a pulse, you are allowed to cardiovert. If he goes into VF or pulseless VT, on the other hand, the situation constitutes cardiac arrest and you should not enter the ACLS protocol.

When a patient is DNR (do not resuscitate), many doctors hold off on vasopressors and strong antibiotics or interventions such as pacemaker or even ventilators for respiratory distress. This is incorrect. This is the kind of situation that exams like to test on.

If you think it is not appropriate to use pressors or cardioversion or antibiotics because you deem them futile, you have to address each one separately and specify on the consent form.