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An apparent 19-year-old male is brought to the emergency room by ambulance in respiratory failure related to end stage cystic fibrosis The patient is accompanied by his girlfriend who states that the patient has a do not resuscitate DNR order As the emergency room physician tries to contact the patients primary care physician he finds that the patient is under the care of a pediatrician which makes him suspicious of the DNR request He confronts the girlfriend about the patients age because the patient is unable to communicate due to his respiratory condition The girlfriend breaks down and admits that the patient is actually 17 years old The physician immediately intubates the patient in an effort to stabilize his respiratory condition The patients respiratory condition is stabilized after a short time and he is extubated The patient relates to his nurse that he does not want to be intubated again or placed on a respirator The nurse relays this information to the physician who at this point does nothing The patients mother arrives at the emergency department and the physician explains the patients condition and his request for a DNR order His mother refuses to sign a DNR order and this information is explained to the patient by the physician with the mother present A discussion insues between the mother and her son and she reluctantly agrees to sign the DNR order The physician is informed of her decision and assists the mother in signing the appropriate paperwork The patient soon confronts the physician and makes him promise to stick to the DNR order no matter what his condition the physician agrees Shortly after the DNR is completed and all other appropriate paperwork are in order the patient goes into respiratory arrest All the parties involved in this situation are present when the respiratory arrest occurs The physician stands by will all intentions of honoring the DNR but within 30 seconds of the arrest the
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