DO-NOT-RESUSCITATE
ORDER
An 84-year-old man has metastatic small cell carcinoma of the lung. He presents with hoarseness and a 2 kg
weight loss. An investigation reveals tumor in the mediastinal lymph nodes and
two 1 cm lesions in the liver, which are currently asymptomatic. The patient
has prepared a living will stating that he does not want any heroic measures
such as intubation and cardiopulmonary resuscitation in the event that he
should suffer a cardiac arrest. He will accept a feeding tube if he should
become unable to feed himself. The patient pres-ents to the operating room for
placement of a tunneled cen-tral venous catheter for chemotherapy. While the
surgeon is infiltrating the surgical site with local anesthetic, it becomes
apparent that an excessive dose of local anesthetic has been injected. The
patient suffers a grand mal seizure.
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