What is a DNR and DNI?

A DNR (do not resuscitate) and DNI (do not intubate order) can drastically alter what happens once you enter a hospital environment. However, before we discuss the orders, you first need to understand just a little about what happens when a person's heart stops, and what we do to help.

What we commonly refer to as someone’s heart stopping, is rarely actually the heart stopping. There are several lethal heart rhythms that get grouped into this category. Once you go into any of them, the steps to getting your heart beating again are very regimented.

First, chest compressions. Your heart isn’t pushing blood forward, so your organs start to shut down. We put pressure on your chest for you to force blood forward. The risks involved with compressions include broken ribs (common), or a collapsed lung (uncommon).

Next you get medicine. An IV is started and you’ll be given a couple of different medicines (depending on what heart rhythm you’re in) to try to make your heart behave.

Lastly, in certain heart rhythms, electricity. Your heart beats because of a small electrical impulse. When we shock someone (called defibrillation), what we try to do is to stop your hearts crazy rhythm for a fraction of a second so it can have that moment of clarity and work correctly again.

After all this, or if this process takes a long time, we would place an artificial airway (breathing tube) to get oxygen to your body.

A DNR order simply states that you do not want us to try to get you back if your heart stops. If you have a DNR and this happens, the medical professionals would simply try to make you comfortable (you’ll be unconscious), silence any alarms, and notify family.

A DNR ONLY changes what’s done if your heart stops. It has no effect on the rest of your treatment.

A do not intubate order means you don’t want a breathing tube. Everything else mentioned earlier would be done except for the last part. This doesn’t mean that you wouldn’t be placed on oxygen or BiPAP/CPAP (a mask to help you breath).

It is possible to specify which parts of a resuscitation you want done. For example, you could choose not to have compressions, but to receive medicine. I would strongly advise against this, and here’s why.

Once your heart stops pumping blood, the medicine that we would give won’t go anywhere, it would sit in the vein where we push it in. Without that movement, it will have no effect at all.

At the same time, if you do not want to be shocked out of a dangerous rhythm, that has one major flaw. There are several heart rhythms where the one and only treatment is a little electricity. We could do everything else, but if we aren’t allowed to do the one thing to fix your heart, then it will be for nothing.

However, as the patient, it is entirely your decision. Always remember that you have the power and control.

An out of hospital DNR/DNI is different from a normal DNR/DNI. If your heart stops at home and an ambulance is called, they will try to bring you back unless someone nearby can actually show them the signed out-of-hospital DNR/DNI.

A DNR/DNI also has little bearing during an operation. You can obtain an in-procedure DNR, but you will have to push to obtain one from the doctor prior to the procedure/operation.

And finally, a DNR/DNI is not valid in the presence of pregnancy. Very specific situations and conditions have to be met to have a DNR during pregnancy, and they change from state to state.

This one is easy(ish). Schedule an appointment with your primary doctor and have a frank discussion about your wishes. Your doctor has to provide the DNR order, so tell them your wishes and obtain the DNR/DNI from them.