Question: Just some clarification in regards to DNR's. If a patient is having an episode of an exacerbated Asthma and has a valid DNR, do we administer Epi for the asthma? I understand that we cannot "bag" the Patient due to the DNR status.

 Great question. We are frequently asked questions related to the DNR standard and the limits of care that are related to this standard. A copy of the standard and an accompanying training bulletin can be found on our website here: www.lhsc.on.ca/About_Us/Base_Hospital_Program/No.108V.1.0DNRStandard.pdf

To answer your question specifically, you are correct that insertion of an oropharyngeal airway and bagging the patient would be considered artificial ventilation and this is specifically contraindicated on the DNR confirmation form. However, symptom relief medications can and should still be administered and this would include epi for asthma.

That being said, one should be certain of their diagnosis of asthma exacerbation prior to administering epinephrine. Most patients with DNR's tend to be elderly and it would be difficult to determine if their shortness of breath is related to a true asthma exacerbation or other causes of shortness of breath more common in the elderly such as COPD, CHF, pneumonia, aspiration etc€¦.

Airway/Breathing,Bronchoconstriction,DNR,Miscellaneous

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