ICU PATIENT CARE: SERIES OF BASICS - 2
13 July 2020
The problem we Pharm D professionals face is global. We’re called as Doctors and still we lacked the “DOCTOR PERSPECTIVE”. To overcome this scenario we need to view a case in a holistic manner and never hesitate to ask doubts with the Doctor in-charge and the Nurse in- charge because they spent the major time with the patient. But to ask the doubt we should be aware of the significance, of factors governing patient health.
In last article we came across the checklists to follow in ICU rounds. In this article, I’ll start with the significance of CODE STATUS.
It essentially means the type of emergent treatment a person would or would not receive if their heart or breathing were to stop. The patient may not be able to fully communicate their personal wishes related to treatment options. So it is important to have some basic understanding of these treatment choices before a crisis occurs.
All patients who are admitted to a hospital are assigned to a code status. The treatment consists of FOUR categories:
# Cardiopulmonary Resuscitation (CPR): Attempt to physically stimulate the heart.
# Defibrillation: Attempt to electrically stimulate the heart using electrical shocks via pads or paddles.
# Specific cardiac arrest medications: Attempt to chemically stimulate the heart using medications (eg: Adrenaline)
# Intubation and mechanical ventilation: Involves placing a breathing tube that can be connected to a ventilator if a patient cannot breathe on their own.
Since a cardiac arrest or respiratory arrest can happen unexpectedly it is best to be prepared ahead of time. A code status decision can be changed at any time. It depends upon the factors such as:
# Severity of the disease
# Cause of arrest
# Other age related factors
Level of Code Status
• Full resuscitation – all resuscitative and aggressive curative treatment are provided.
• Do Not Attempt Resuscitation (DNAR) or Do Not Resuscitate (DNR) – order designating that in the event of a cardiac or respiratory ARREST, resuscitation will not be attempted. All other aggressive treatment desired will be provided as appropriate.
• Comfort Measure Only - In the event of a cardiac or respiratory ARREST, ALLOW NATURAL DEATH. Do NOT attempt resuscitation (CPR, Cardiac Arrest Medications, Defibrillation, and Intubation). AGGRESSIVE TREATMENT WILL BE DISCONTINUED OR NOT PROVIDED and only treatment to promote comfort will be provided.
Code status vary from institution to institution.
Other Life-Sustaining Treatments:
# Dialysis or Kidney transplant
# Tube feeding
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