1. TRIAD VI PA Emergency Medicine Experience with PA-POLST Only for Scientific Presentations Ferdinando L. Mirarchi, D.O.FAAEM, FACEP Principal Investigator © Mirarchi, 2013

2. TRIAD VI-PA Emergency Medicine Experience with POLST 1. Based on this POLST document, what is the patient's code status? © Mirarchi, 2013

3. TRIAD VI-PA Emergency Medicine Experience with POLST What is your understanding of DNR? © Mirarchi, 2013

4. Case A: A 66-year-old female presents with complaints of chest pain, shortness of breath and diaphoresis. Vitals: P:110; RR:30; SaO2: 97%RA; T: 37C; BP: 130/70. Patient has been given oxygen, aspirin, and nitroglycerin enroute. Pre-hospital ECG shows acute ST elevation anterior wall myocardial infarction. EMS presents you with a list of medications and their POLST Document. Abruptly her status changes as you evaluate her. She becomes unresponsive and develops VT/VF arrest. © Mirarchi, 2013

5. Case A: A 66-year-old female presents with complaints of chest pain, shortness of breath and diaphoresis. Vitals: P:110; RR:30; SaO2: 97%RA; T: 37C; BP: 130/70. Patient has been given oxygen, aspirin, and nitroglycerin enroute. Pre-hospital ECG shows acute ST elevation anterior wall myocardial infarction. EMS presents you with a list of medications and their POLST Document. Abruptly her status changes as you evaluate her. She becomes unresponsive and develops VT/VF arrest. © Mirarchi, 2013

6. Case B: A 70-year-old male presents with a history of diabetes, hypertension, dyslipidemia, and CAD s/p CABG 10 years ago. Patient is experiencing chest pain. He is clammy. He is in mild distress. Vitals: T: 36C; P:60; Bp:100/60 RR:22; SaO2: 98%RA. The family gives you his list of medications and POLST document. Abruptly, the patient becomes unresponsive without palpable pulses. The monitor shows ventricular fibrillation. © Mirarchi, 2013

7. Case B: A 70-year-old male presents with a history of diabetes, hypertension, dyslipidemia, and CAD s/p CABG 10 years ago. Patient is experiencing chest pain. He is clammy. He is in mild distress. Vitals: T: 36C; P:60; Bp:100/60 RR:22; SaO2: 98%RA. The family gives you his list of medications and POLST document. Abruptly, the patient becomes unresponsive without palpable pulses. The monitor shows ventricular fibrillation. © Mirarchi, 2013

8. Case C: An 87-year-old male presents with a complaint of sudden shortness of breath. Patient is agitated, confused, and in severe respiratory distress. Vitals: P:130; RR 50; BP: 70/50; T:37C; SaO2: 78% on nonrebreather. The patient's wife gives you a list of medications and the POLST document. Abruptly, while examining him, the patient goes into respiratory arrest. © Mirarchi, 2013

9. Case C: An 87-year-old male presents with a complaint of sudden shortness of breath. Patient is agitated, confused, and in severe respiratory distress. Vitals: P:130; RR 50; BP: 70/50; T:37C; SaO2: 78% on non-rebreather. The patient's wife gives you a list of medications and the POLST document. Abruptly, while examining him, the patient goes into respiratory arrest. © Mirarchi, 2013

10. Case D: A 66-year-old female presents with complaints of chest pain, shortness of breath and diaphoresis. Vitals: P:110; RR:30; SaO2: 97%RA; T: 37C; BP: 130/70. Patient has been given oxygen, aspirin, and nitroglycerin enroute. Pre-hospital ECG shows acute ST elevation anterior wall myocardial infarction. EMS presents you with a list of medications and their POLST document. Abruptly her status changes as you evaluate her. She becomes unresponsive and develops VT/VF arrest. © Mirarchi, 2013

11. Case D: A 66-year-old female presents with complaints of chest pain, shortness of breath and diaphoresis. Vitals: P:110; RR:30; SaO2: 97%RA; T: 37C; BP: 130/70. Patient has been given oxygen, aspirin, and nitroglycerin enroute. Pre-hospital ECG shows acute ST elevation anterior wall myocardial infarction. EMS presents you with a list of medications and their POLST document. Abruptly her status changes as you evaluate her. She becomes unresponsive and develops VT/VF arrest. © Mirarchi, 2013

12. Case E: A 52-year-old male presents with complaints of chest pain, shortness of breath and diaphoresis. Vitals: P:110; RR:30; SaO2: 97%RA; T: 37C; BP: 130/70. Patient has been given oxygen, aspirin, and nitroglycerin enroute. Pre-hospital ECG shows acute ST elevation anterior wall myocardial infarction. EMS presents you with a list of medications and their POLST Document. Abruptly his status changes as you evaluate him. He becomes unresponsive and develops respiratory arrest in the Emergency Department. © Mirarchi, 2013

13. Case E: A 52-year-old male presents with complaints of chest pain, shortness of breath and diaphoresis. Vitals: P:110; RR:30; SaO2: 97%RA; T: 37C; BP: 130/70. Patient has been given oxygen, aspirin, and nitroglycerin enroute. Pre-hospital ECG shows acute ST elevation anterior wall myocardial infarction. EMS presents you with a list of medications and their POLST Document. Abruptly his status changes as you evaluate him. He becomes unresponsive and develops respiratory arrest in the Emergency Department. © Mirarchi, 2013

14. Case F: An 90-year-old male presents with a complaint of sudden shortness of breath. Patient is agitated, confused, and in severe respiratory distress. Vitals: P:120; RR 46; BP: 84/60; T:37C; SaO2: 72% on non-rebreather. The patient's wife gives you a list of medications and the POLST document. Abruptly, while examining him, the patient goes into respiratory arrest. Pink DNR comments. © Mirarchi, 2013

15. Case F: An 90-year-old male presents with a complaint of sudden shortness of breath. Patient is agitated, confused, and in severe respiratory distress. Vitals: P:120; RR 46; BP: 84/60; T:37C; SaO2: 72% on non-rebreather. The patient's wife gives you a list of medications and the POLST document. Abruptly, while examining him, the patient goes into respiratory arrest. © Mirarchi, 2013