Topics Discussed: brain death; ethics; withholding treatment.
Sections: Withholding or Terminating Resuscitation, Brain Death, References.
Excerpt:"
- A patient with an advance directive to not resuscitate (a DNR order) may be treated but not resuscitated in the ED.
- Lacking advance directives, all children including those who are terminally ill must be provided with resuscitation. Rarely is there time or resources in the ED to initiate a conversation that would lead to a sound DNR order.
- There is no standard of care that dictates the duration of resuscitation for infants, children, or adolescents. The duration of resuscitation is at the discretion of the treating physicians.
- Brain death in infants and children typically cannot be determined in the ED because of the observation period required. To diagnose brain death, a set of criteria must be met that includes a compatible clinical history, a physical exam consistent with brain death, and may require supportive studies to definitively establish this diagnosis.
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