Critical Care and End-of-Life Issues (cont.)

Moderator: If someone is going under general surgery what can be done to lessen his or her risks of complications?

Dr. Sample: Any surgery whether it requires a general anesthetic or even a regional anesthetic... the patient should follow some good common sense rules. If you're a smoker, you should stop smoking. If you have high blood pressure or heart conditions, you should stay on your medicines, and in all instances, you should see your primary care physician for clearance. And in some instances, perhaps, more than most docs would admit, I would ask if there's an intensivist at that hospital if something ... if there's a complicating.

DebbieDavis_WebMD: Are you affected by the on the job trauma that occurs daily? How do you cope?

Dr. Sample: Absolutely yes. It is impossible to avoid the impact by the patient's struggle with life, the terror in families' eyes. Part of the coping mechanism is the collaboration within the critical care team. The other is the support from your colleagues, the critical care team, family, and watching ER for laughs on occasion.

Moderator: What does DNR mean? When is it implemented?

Dr. Sample: DNR stands for Do Not Resuscitate. It is an order that is written on the patient's chart that instructs physicians and nurses not to attempt to restart the patient's failed heart or respiration. It is implemented at least in those 3 instances that I mentioned earlier, about the grave prognosis, the burden of therapy, the quality of patient's life is unacceptable. We have a generic term called "medical futility" that encompasses this concept. That is, when all has been done, and all will be lost, the patient should have a DNR order placed on the chart. The next step is to talk to family about the withdrawal or the foregoing of life support as I mentioned at the beginning of the show.

Moderator: We are almost out of time Dr. Sample. Is there anything else you would like to add before we say good bye?

Dr. Sample: Thanks for this opportunity. Hope I can do it again. If the "lurkers" have specific questions, they can email me at

Moderator: Unfortunately that's all the time we have. I would like to thank Dr. George A. Sample, for being our guest speaker on WebMD Live this afternoon. This discussion has been very informative. I encourage WebMD members to check the program schedule to see what other shows we have coming up. Thank you and have a wonderful day.

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