We've had different experiences, I dare say.
Outside of the surgical/critical care world, what's your experience with CPR?
With patients found dead when the nurses make 5:30 AM rounds, for example? Or bleeders who go asystolic when the blood comes out faster than you can put it in?
It's a serious issue. New York State mandates CPR unless declined in writing as a "pro-life" measure, but most of MY patients who arrest do so because everything done to prevent it has failed.
Acute MIs? Absolutely yes. End of life CMO people who signed the paper? Absolutely not.
People who die overnight in an unmonitored bed with cancer, AIDS, cirrhosis and liver failure?
Them, I'm not so sure it should be a requirement.
I've done it, and not done it, a lot since July 1, 1974. I think the current regulatory and legal environment promotes "slow codes" when "no codes" sould be at the doctor's discretion based on circumstances in the moment.
When I was a senior on call, I used to carry an ophthalmoscope for exactly this reason. Fixed, dilated, blood clotted in retinal veins? No code.
Which is, IMO, as it should be.
I agree with you on some points. Of course I have see. A patient who is in rigor. I didn’t initiate CPR. I have handled major traumas and pumpers. I have placed large lines and rapid infusers work sometimes. Sometimes they don’t. A blown aortic aneurysm game over unless there is a surgeon. What I think you are getting at is that a physician can say I am not going to start CPR becuase there is no benefit. I am comfortable with this decision. In other words most law says that I cannot be compelled to proceed in a futile condition. Not sure that is entirely a proliferation legislation but I would prefer that in the absence of a physician with years of clinical expertise and acumen that nonphysician providers be required to follow protocols. And yes I have extensive experience in ACLS in the field and all hospital settings. Your points are well taken
Resuscitation of a hopelessly ill, terminal patient, often done for fear of lawsuits, often adds $300-400,000 dollars worth of futile care and the year on the tombstone does not change. Unreasonable expectations from families, Monday morning quarterback “patient advocates and most of all prowling lawyers have resulted in a system where the good judgement of the attending physician is overridden by policies made by corporate committees.