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The Realities of Advanced Medical Interventions Micki Jackson , coordinator Approximately 90 minutes with time for ?’s laterHandouts : WAHA, list of medical terms used CPR- Cardipulmonary Resuscitation Mechanical Ventilation- Respirator (breathing support) Pressors-Intravenous drugs to support blood pressure Artificial Nutrition- feeding tubes Dialysis-kidney function 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 200,000 in-hospital cardiac arrests 18.3 % survive to discharge No improvements since 1992 -American Heart Assoc BUT…… Percentage discharged to home is less Discharges to hospice (17x) and long term care facilities (6x) increased 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 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% Medicines given intravenously 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? 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? 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 Palliative Care- a team that focuses on providing specialized care to relieve the symptoms, pain and stress of serious illness. Hospice -support in the community Comfort Care- final hours/days in hospital www.whatcomalliance.org ? “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?”