Download The Art of Death: Realities of Advanced Medical Interventions

The Realities of Advanced Medical Interventions
Micki Jackson , coordinator
Approximately 90 minutes with time for ?’s laterHandouts : WAHA, list of medical terms used
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CPR- Cardipulmonary Resuscitation
Mechanical Ventilation- Respirator (breathing
support)
Pressors-Intravenous drugs to support blood
pressure
Artificial Nutrition- feeding tubes
Dialysis-kidney function
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In the US 540,000 people experience cardiac
arrest each year-most out of hospitalAge range- birth to 100+ years
5-15% survive to hospital discharge
What do these survivors have in common and
how are they very different?
Our survival rates have improved- EMS,CPR,
medications, devices
Circulation 2013
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200,000 in-hospital cardiac arrests
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18.3 % survive to discharge
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No improvements since 1992
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-American Heart Assoc
BUT……
Percentage discharged to home is less
Discharges to hospice (17x) and long term care
facilities (6x) increased
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CPR- cardiopulmonary resuscitation
“The heart is compressed to a depth of 2
inches by squeezing it between the rib cage
and the spine”
Blood is squeezed out of the heart and
pumped to the brain and other organs
Who gets CPR?
Who gets good CPR
AED’s-automatic external defibrillator- not
all heart rhythms are “shockable”
10%
7%
died during
49%
35%
died before
discharge
died after discharge
alive at 1 yr
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Cerebral Performance Categories
Age
% of survivors with good neuro logical function or minimal deficits
on discharge (could be CPC1 or 2)
<70
12.6%
70-74
10.2 %
75-79
8.6%
80-84
7.6%
>-85
4.5%
Reason for hospital admit
% survival to discharge with
“better” outcome (CPC 1)
Major trauma- broken
bones
6%
Acute stroke- bleed or clot
3.7%
Cancer-tumors
5.2%
Blood infection-sepsis
3.6%
Liver function poor
4.4%
Admitted from a skilled
nursing facility
3.2%
Kidney function poor
6.4%
Pneumonia
5.2%
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Medicines given intravenously
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Your doctor
Your nurse
Your family
Joan Rivers 81 yrs old
Routine upper GI scope exam because she had
voice changes and indigestion
She stopped breathing during sedation for the
procedure and suffered brain damage from lack
of oxygen
Quote from the ME…… “resulted from a
predictable complication of medical therapy”
ALL elective and emergent procedures have
predictable complications- do you understand
the real risk?
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Where will you live?
New medicines and treatments
Communication and memory
Who will take care of your daily needs
Who is left at home if you can’t be there
It’s expensive and who pays- do you have LTC
insurance?
What will your Medicare cover?
What about Medicaid?
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Deciding not to have CPR (“DNR” means do
not resuscitate) does NOT mean no carepatients may still want life support
treatments in a hospital or ICU.
Antibiotics, IV fluids and other medical
treatments are available
Nurses help patients stay comfortable- you
get the care you need and WANT
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Palliative Care- a team that focuses on
providing specialized care to relieve the
symptoms, pain and stress of serious illness.
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Hospice -support in the community
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Comfort Care- final hours/days in hospital
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www.whatcomalliance.org
?
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“We need to stop treating CPR as something special -ie
a default action; as something that is a genuine medical
option even when it’s therapeutic potential is remote”
“It’s the only thing in medicine that we treat this way,
like it’s a sort of human right, as opposed to a
complicated medical procedural intervention with
indications and contraindication, good reasons to do it,
and good reasons not to….”
“Hospital QI compartments must start looking at
questions of whether there was an indication for CPR in
the first place and if not—why was it offered/why didn’t
the patient have a DNR order/why weren’t people
discussing this with the patient/family?”