The moment of death in an Internal Medicine ward

• Autor(a) principal: Magalhães, Luísa
• Data de Publicação: 2009
• Outros Autores: Guimas, Arlindo, Ferreira, Sofia, Ribeiro, Rosa, Paiva, Paulo
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1423
• topic: paragem cárdio-respiratória; equipas de emergência médica; decisão de não reanimar; cardiorespiratory arrest; medical emergency teams; do not resuscitate

Background: In-hospital cardiorespiratory arrest (CRA) has a severe prognosis, but is usually preceded by alert signs. These signs should be recognized and necessary procedures predicted. Methods: Retrospective evaluation of alert signs and symptoms in the 6 hours before death, decision of Do Not Resuscitate (DNR) and attitudes chosen in deceased patients in a 3 year period. Results: Four hundred and three patient files were reviewed (mortality rate 11,4%). Mortality was homogeneously distributed in respect to week day and time. Alert signs and symptoms in the 6 hours before death were identified in 291 patients (72,2%), specially: depressed level of consciousness (129 patients), desaturation (104) and dyspnoea (92). Doctors were called in 133 cases and their attitudes were: reversion in 70 patients, relieving in 67, no attitude at all in 60 and assuming DNR in 40. The DNR was present in 348 patients (86,4%) and registered in 92,0%. Cardio-pulmonary resuscitation (CPR) was attempted in 2 patients (0,5%) with explicit DNR and in 1 (0,2%) with implicit DNR. CPR was not attempted in 35 patients (8,7%), although there was no recorded indication in the patient file for DNR.Conclusions: Alert signs and symptoms preceded most CRA, allowing an opportunity for intervention. Mostly nurses identified these signs. The indication for DNR was recorded in the files of most patients. The low number of patients with indication for CPR is a surrogate of patient’s complexity. This study reinforces the need for intervention in recognition, evaluation and decision in the pre-arrest patients.