Question: There is certainly a lot of confusion that remains in regards to DNR's. From your replies, I get the impression that if someone is breathing, has a pulse and a valid DNR, but has respiratory or cardiac problems which may or may not be corrected with artificial ventilation, assisted ventilation without an artificial airway (conscious CHF)or chest compressions we are to provide NRB O2, symptom relief meds and comfort measures. That being said, if someone has a valid DNR becomes obstructed with a FB, we have been instructed by BH personnel to attempt to clear the FB and if death results in the process, validate the DNR and stop the efforts. If this is correct, are we not providing or at least attempting to provide A/R in one of the steps to alleviate the obstruction? This would be in contraindication to past answers which the committee has provided. Not trying to be a pain, just looking for clarity for viewers and myself. Great site €“ your time and effort is appreciated.

 Thanks for your question. We agree with your understanding in the first paragraph. As for the foreign body airway obstruction in a patient with a valid DNR, answers to this question have been posted on this site multiple times.

The duty of all paramedics and front line providers is to assist patients. A valid DNR does not preclude a paramedic from attempting to assist a patient who is choking. However, once a patient has suffered a cardiac arrest -for whatever the reason- and this patient has a valid DNR, then the DNR is to be followed as described.

The DNR Patient Care Standard specifies that there may be situations which call for aggressive treatments that may be considered life saving in order to manage an unforeseen and immediately correctable condition. These measures (and we would include working to alleviate an obstructed airway in a choking patient with a valid DNR who has not suffered a cardiac or respiratory arrest as one of these situations) should be considered and utilized as appropriate. Again however, if the patient suffers a cardiac arrest despite your airway clearance attempts as per the Basic Life Support Patient Care Standard for Airway Obstruction, then follow the DNR Standard.

A link to the DNR Standard can be found on our website here: www.lhsc.on.ca/About_Us/Base_Hospital_Program/No.108V.1.0DNRStandard.pdf

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