Emergency Dept Physicians report question

Factual Questions
1

Approximately 3 months ago I went into the ER with pretty bad shoulder pain. I requested the Drs report so I can give it to my new family doctor. I received the report and under óther information’it says under code status: Patient is a full code. I had an MRI done and the findings were: rotator cuff sprain and tendinitis, shoulder. IMPRESSION: mild rotator cuff peritendinitis and mild subacromial bursitis, without high-grade partial or full-thickness rotator cuff tear. FYI: I take Pradaxa daily due to atrial fibrilation.

I am confused at what the 'Patient is a full code’means.

Thank you.

2

Pretty sure:

If something happened to you - say a heart attack or a stroke - they should do everything they can reasonably do. The standard. As opposed to someone who has a fatal disease and who has specified in advance that they do not want heroic measures used to save their life if something was to occur with some variant of DNR i.e. do not resuscitate.

I am not an Emergency Department Doctor.

3

To expand a bit, at hospitals where I’ve worked as a medical student, “full code” means if your heart stops, they’ll use electrical cardioversion to zap it back into a normal rhythm, they’ll do chest compressions to keep your blood pumping while they try to restart your heart, they’ll put a tube down your throat and use a ventilator if you stop breathing, and they’ll use drugs to increase your blood pressure if it is very dangerously low. Patients can have code statuses specifying which if any of those measures will be taken.

4

It may be helpful to consider “no code,” the label for patients who have requested that there be no efforts at resuscitation whatsoever. So called because of the PA announcement which assembles the “crash” team: Code Blue (in most places).

5

It’s a lot better than finding out later they mistakenly had you listed as “no code”. :slight_smile:

6

the meaning of full code and no code are very different and only one word changes the meaning; potential for confusion.

maybe some very distinct terms like bear claw and donut hole should be used instead.

7

Generally people will say DNR instead of no code. One hospital system here uses the phrase “full LET” , which I think stands for “limitations on emergency treatment.”

8

As mentioned above, there are other options besides DNR and No Code that apply during a cardiac event. DNI is probably the most common - Do Not Intubate. It means “if my heart stops, go ahead and zap me with the zappy thingy*, push on my chest, give me drugs to try to start my heart again…but don’t put a breathing tube down my throat.”

You can also write orders that allow the zappy thing and pushing on the chest, but no drugs to try to restart the heart. With or without intubation. Or push on my chest and give me drugs, but no zappy thing (but that’s not very common). Code words for those vary by institution.

Also, although nobody’s brought it up, let me just fight this straw man I’m about to introduce: DNR does not mean do not treat. It’s a common misconception, that if you have a DNR, we won’t treat whatever you’ve got as aggressively. Wrong, wrong, wrong. DNR *only *comes into play when your heart stops (and you’re not breathing, 'cause that’s what happens when your heart stops). It does not dissuade us from giving you drugs to try to *prevent *your heart stopping in the first place, or clot-busting drugs, or antibiotics, or surgery, or food and water. It’s not a death wish, it’s an instruction that once your heart stops on its own, we let it stay stopped.

Anyone over the age of 18 who doesn’t have them written already, please go here and get the damn Advance Directives done and give them to your nurse. It totally sucks if I’m standing there and you’re dead and I don’t know what you want me to do about it.
*Anyone who comes in to point out that you don’t defib asystole can go play with the pedants. This thread is for laypeople.

9

To WhyNot:

After much nagging from the staff of our primary care physician, Hubster and I finally completed the Advance Care Directives. The business office of the clinic would not serve as witnesses, and since many banks do NOT have notaries handy any more, I took the paperwork with us to a party, and snagged people to serve as witnesses.

Right as the party was winding down, Hubster had to be transported by ambulance to the nearest hospital for a MAJOR kidney stone attack–his first.

My son met me at the ER, and stayed with me while we waited (and waited and WAITED) for Hubster to be discharged. I pulled those Advance Care Directives out of my purse, and MADE my son read them, so there would never be any question.

He was quite pissed at being my captive audience. He told me that he’s already given us his consideration, and as far as HE is concerned, his father and I will not be permitted to die. Period.

With THAT out of the way, I explained that he and his new bride REALLY need to have a serious talk about this disgusting topic. I reminded him of the media mess several years ago regarding Terri Schiavo.

In fact, when the Schiavo drama was being played out before God and everybody, I flat out told my son-in-law that I would NEVER, EVER question any decision he would ever have to make regarding my daughter’s care. He gave me a very heart-felt “Thank you.”

I said the same thing to my son: Since he was of legal age and married now, how he and his new bride cared to handle ANY end-of-life decisions was NONE OF MY BUSINESS.

But I definitely told him that it was THEIR business, and even though the idea is abominable, they really do need to have that discussion.

Then I took the papers back, put them in my purse, and we talked of more entertaining subjects, like his father’s kidney stone.
~VOW

10

And that’s exactly when and why you need those papers. Those papers are worth nothing more than firestarter if everyone agrees What Mom Would Want. Those papers are for when kid disagrees with kid, or spouse, or doctor. It’s SOOOOOOO much easier to agree What Mom Would Want if Mom has a piece of paper *saying *what she wants.

It’s also worth nothing that a family member is, sometimes, not the best person to give Power of Attorney for Health Care to, or to keep those papers safe. Sometimes a friend or coworker who is a little more emotionally removed from the situation is a better choice - they still care about you, and if you have some conversations, will know what you want, but they’ll not be a blubbering mess with their own emotions clouding the issue and causing angst and guilt.

11

I would like to change my designation from ‘Full Code’ to ‘Donut Hole’ effective immediately. Thank you.

12

The paperwork is on file in our individual medical records at the clinic where our primary care physician is located. They scanned the originals and returned the originals to us.

I absolutely agree with everything you said. This was the unfortunate circumstance of both my mother’s and my father’s deaths. There was NO disagreement, my sister and I knew exactly what our parents wishes were. When it was determined that further treatment would do absolutely no good, we told the doctor and staff to stop the medications, stop the respirator, stop EVERYTHING and leave them in peace.

It’s a wretched, wretched decision, but it would have been beyond agony if people were having fist fights in the hall.

(and I’ve heard ALL about those!)
~VOW

13

I want “ticklish” listed for me. Cause I tend to be.

14

When the time comes for me, I want NO life-prolonging treatment, but MAXIMAL palliative treatment. Is there a “code” for that?

Who can I designate to make (who can I trust to make) medical decisions for me when I can’t, if I have no family or friends?

15

Yes, sort of. It would be having a DNR while in hospice care. Hospice care is covered by most insurance and Medicare if a doctor will sign a paper saying you probably have less than 6 months to live. It can be done in a hospital, in a dedicated hospice facility, skilled nursing facility or at home. Specific benefits and limits will vary depending on location and policy. (You do not, interestingly enough, *have *to have a DNR to be in hospice, despite popular belief.)

I believe you can designate a lawyer for this. You could, if you so wished and he agreed, appoint the guy who stacks the apples at the supermarket. I believe the only people who can’t be your PoA, or witness to your PoA, are your doctors, nurses and other care providers and employees of the health care company(ies) providing your health care.

But your best bet is probably to spend a morbid couple of days thinking up everything that could go wrong, and write detailed instructions for each scenario you dream up. This would be a Living Will, and it’s a good choice for those in your situation, for whom a PoA might not be the best option. Aging With Dignity has a lot of good information on how to get started. And yes, “in the event I develop a fatal condition with a high likelihood of death within 6 months, I wish to receive maximum pain relief without regard to alertness or addiction” is certainly something you can put in there.

But of course, you should check with a medical social worker (which I’m not) in your state (which I’m probably not) to see what’s right for your situation. Every hospital has one, or your doctor can refer you to one. Most insurance and Medicare cover a consultation with a medical social worker once a year for handling stuff like this.