Downloaded from http://emj.bmj.com/ on August 18, 2017 - Published by group.bmj.com
PostScript
LETTER
To CPR or not to CPR? That is the question As emergency physicians, we stand at the frontlines of managing the acute patient. When an unresponsive patient is rushed into the emergency department (ED) and the family demands immediate attention, there is always the question of instituting cardiopulmonary resuscitation (CPR). In situations like these, an advance directive —a legal document in which a person outlines his or her end-of-life care—can be helpful.1 Providing life-sustaining treatment was one of the ethical challenges mentioned by Zafar2 in his study; none of the participants considered advance directives to be pragmatic mainly because of their paucity. In the ED, discussions about code status with the family are often delayed due to the family’s denial or their inability to understand disease prognosis. In other instances, the primary decision-maker’s absence from the scene or unavailability via phone causes postponements and increased medical team frustration. This can lead to arguments and, if unchecked, violence. Training the medical team in conflict avoidance and resolution are ways of improving communication and patient/patient’s
828
family’s satisfaction levels. Awareness about advance directives and code status could be created by using print and electronic media. Given the volatility and unpredictability of today’s world, encouraging all adults to form an advance directive could be empowering. Encouraging one’s parents or spouse to think through such emotionally laden scenarios preemptively might even generate a healthy debate. Having discussions with one’s primary-care provider may be an alternative approach; perhaps primary-care providers could take the responsibility of discussing patient’s overall condition and code status as they are the ones who know their patients the best. The dilemma of CPR may seem to be an insurmountable problem, especially for a country like Pakistan where the concept of advance directives is quite alien. However, if a methodical and multipronged approach is taken, encouraging results may be seen.
▸ http://dx.doi.org/10.1136/emermed-2014-204081
Muhammad Akbar Baig,1 Asad Mian,1,2 Hira Shahzad3
Emerg Med J 2015;32:828. doi:10.1136/emermed-2015-204934
University Hospital, Stadium Road, Karachi 74800, Pakistan; [email protected] Twitter Follow Asad Mian at @asadmian74 Contributors MAB and AM contributed towards conception of idea, drafting and critical editing of the manuscript. HS contributed towards drafting, critical editing and revision of the manuscript. All authors have read and approved the final version of the manuscript. Competing interests None declared. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Baig MA, Mian A, Shahzad H. Emerg Med J 2015;32:828. Accepted 17 April 2015 Published Online First 2 May 2015
1
Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Sindh, Pakistan 3 Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan 2
Correspondence to Dr Muhammad Akbar Baig, Department of Emergency Medicine, Aga Khan
Emerg Med J October 2015 Vol 32 No 10
REFERENCES 1
2
Childress JF. The care of the dying: a symposium on the case of Betty Wright—Dying patients: who’s in control? Law Med Health Care 1989;17:227–31. Zafar W. Moral experience and ethical challenges in an emergency department in Pakistan: emergency physicians’ perspectives. Emerg Med J 2015;32:263–8.
Downloaded from http://emj.bmj.com/ on August 18, 2017 - Published by group.bmj.com
To CPR or not to CPR? That is the question Muhammad Akbar Baig, Asad Mian and Hira Shahzad Emerg Med J 2015 32: 828 originally published online May 2, 2015
doi: 10.1136/emermed-2015-204934 Updated information and services can be found at: http://emj.bmj.com/content/32/10/828.2
These include:
References Email alerting service
This article cites 2 articles, 1 of which you can access for free at: http://emj.bmj.com/content/32/10/828.2#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript
LETTER
To CPR or not to CPR? That is the question As emergency physicians, we stand at the frontlines of managing the acute patient. When an unresponsive patient is rushed into the emergency department (ED) and the family demands immediate attention, there is always the question of instituting cardiopulmonary resuscitation (CPR). In situations like these, an advance directive —a legal document in which a person outlines his or her end-of-life care—can be helpful.1 Providing life-sustaining treatment was one of the ethical challenges mentioned by Zafar2 in his study; none of the participants considered advance directives to be pragmatic mainly because of their paucity. In the ED, discussions about code status with the family are often delayed due to the family’s denial or their inability to understand disease prognosis. In other instances, the primary decision-maker’s absence from the scene or unavailability via phone causes postponements and increased medical team frustration. This can lead to arguments and, if unchecked, violence. Training the medical team in conflict avoidance and resolution are ways of improving communication and patient/patient’s
828
family’s satisfaction levels. Awareness about advance directives and code status could be created by using print and electronic media. Given the volatility and unpredictability of today’s world, encouraging all adults to form an advance directive could be empowering. Encouraging one’s parents or spouse to think through such emotionally laden scenarios preemptively might even generate a healthy debate. Having discussions with one’s primary-care provider may be an alternative approach; perhaps primary-care providers could take the responsibility of discussing patient’s overall condition and code status as they are the ones who know their patients the best. The dilemma of CPR may seem to be an insurmountable problem, especially for a country like Pakistan where the concept of advance directives is quite alien. However, if a methodical and multipronged approach is taken, encouraging results may be seen.
▸ http://dx.doi.org/10.1136/emermed-2014-204081
Muhammad Akbar Baig,1 Asad Mian,1,2 Hira Shahzad3
Emerg Med J 2015;32:828. doi:10.1136/emermed-2015-204934
University Hospital, Stadium Road, Karachi 74800, Pakistan; [email protected] Twitter Follow Asad Mian at @asadmian74 Contributors MAB and AM contributed towards conception of idea, drafting and critical editing of the manuscript. HS contributed towards drafting, critical editing and revision of the manuscript. All authors have read and approved the final version of the manuscript. Competing interests None declared. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Baig MA, Mian A, Shahzad H. Emerg Med J 2015;32:828. Accepted 17 April 2015 Published Online First 2 May 2015
1
Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi, Sindh, Pakistan 3 Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan 2
Correspondence to Dr Muhammad Akbar Baig, Department of Emergency Medicine, Aga Khan
Emerg Med J October 2015 Vol 32 No 10
REFERENCES 1
2
Childress JF. The care of the dying: a symposium on the case of Betty Wright—Dying patients: who’s in control? Law Med Health Care 1989;17:227–31. Zafar W. Moral experience and ethical challenges in an emergency department in Pakistan: emergency physicians’ perspectives. Emerg Med J 2015;32:263–8.
Downloaded from http://emj.bmj.com/ on August 18, 2017 - Published by group.bmj.com
To CPR or not to CPR? That is the question Muhammad Akbar Baig, Asad Mian and Hira Shahzad Emerg Med J 2015 32: 828 originally published online May 2, 2015
doi: 10.1136/emermed-2015-204934 Updated information and services can be found at: http://emj.bmj.com/content/32/10/828.2
These include:
References Email alerting service
This article cites 2 articles, 1 of which you can access for free at: http://emj.bmj.com/content/32/10/828.2#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
