|
As a paramedic, the "DNR" thing is part "folklore", part reality, but not for the reasons you cite. If CPR is ineffective, the result is death. Dangerous? Not particularly. Most people wearing DNR tags (aside: even a DNR tattoo on the chest is not considered legally binding against "heroic measures", unless signed by a physician) do so to provide some measure of what the patient might want (due to life expectancy, illness, etc). Survival rate to discharge is HIGHLY dependant on many, many variables - I mention elsewhere that in certain parts of the country, due to concerted education and well managed/funded EMS systems, survival rates can approach 50% to discharge. You are right, though, successful CPR isn't going to negate the underlying cardiac condition. If CPR buys a patient a year to five years, the pain of broken ribs is probably fairly minor in the grand scheme of things. There are, as mentioned, a whole host of advances. My home EMS system does some fairly deep analysis of all CPR attempts and works to revise protocols, including what drugs to administer, through to 'continuing compression through defib shock' (studies done on medical students showing it to be a viable possibility). Ultimately, education is the key - the ability to get skilled compressions more quickly on the chest, continuing to perfuse the brain and other organs has a huge impact in survivability, as well as damage done. |