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Discussion in 'Emergency Medicine' started by uclacrewdude, Mar 25, 2004.
do any of you know anyone with "no code" tattooed across their chest?
Yes, several news stories over the past few years have reported patients getting "DNR" tattooed on their chest.
No, but I once had a patient with a tatoo of the devil on his forehead.
I once saw a patient with a checklist of code choices tattoed on him. I can't remember which things he wanted and which he did not. My recollection was that the list included CPR, drugs, defibrillation, and intubation and he chose only 2 out of 4. The list was on his arm.
i assisted on an autopsy once on a guy with "Flamethrower" tattooed over his suprapubic area.
i think maybe he had some longstanding STD's or something, lol.
Stupid question, but from a legal standpoint would you still need to see actual documentation?
I heard you were a 'flamethrower' homonculus...
I would expect that "tattoo documentation" might not hold up so well in court.
In my EMT class, we were told that even if the patient's spouse, the mailman, and the parish priest all insist there is a DNR, for the care-giver to be legally okay in NOT providing treatment, the document has to be present. One guy had a little sign by his back door saying 'DNR,' and it turned out not to be needed. But we told him he should amend the sign to say 'DNR... (is in the top desk drawer in a blue envelope).'
"back door?" Man you EMS guys are thorough.
My personal feeling is that if someone has gone to the trouble of tattooing it then their intentions are pretty clear. I realize that laws and practices vary from state to state and that the standard is different for prehospital and in hospital providers. I generally accept the patient's statement, a wrist band or necklace, or statements from next of kin and I have been told by medicolegal people that this is OK. Obviously, if it was a 25year old with no medical problems I would question it but in somebody who clearly is approaching the end of their life it seems a stretch to force a full rescusitation on them just because somebody forgot to go to the file cabinet before coming to the ER. On the other hand I have had people with signed DNR's suddenly change their mind when they get sick and if they clearly express that they have changed their mind I feel I need to respect that.
If you are still in med school or residency it is something to ask the medicolegal people at your institution to give you a talk about. You might be surprised that the law isn't as rigid in requiring a specific signed form as you think it is.
Agreed. A lot of times we'll do a "soft code" if we're pretty sure there's a DNR but we may have a faxed copy, or the nurse knows the family, blah blah. That's more for up on the floors, IMHO, though.
One of the more elderly medics that instructed my aemt-i class had "DNR" tatooed on his chest...
that's odd, 'cause I heard you were a "flamecatcher" kungfu...
Quinn brought up "soft codes". Definitely been involved with a few of those. "quick, turn off the EKG before it catches any rhythms!!" lol
Is having DNR written on your chest even valid in any state? Here in my state, unless you have DNR forms signed by a physician, witness, and patient/reprentative; family members can scream bloody murder but the EMS personel and physicians are obliged under law to run a full code. In the past, we've even told familes not to call EMS until they are sure that the patient is dead just to avoid any possible confusion.
A good lawyer could probably create a big stink about a DNR tattoo if medics elect not to do CPR. I don't think the lawyer could win, but I think it would cause a lot of grief and wasted time.
Should the DNR tattoo also have a tatoo of the person's signature?
We just finished a jurisprudence class and delt with this issue. In Texas, if you know the desires of the patient, you have to follow that. We still have formal DNRs and advanced directives with complex forms that must be followed; but a doctor who, in good faith, doesn't code a patient (because he has reason to believe that's what the patient wants) has protection under the law. The DNR tattoo would seem to qualify as good evidence as to patient intent.